Incidence, Treatment and Outcomes of Coronary Artery Dissection During Percutaneous Coronary Intervention
Elizabeth Page, Spyridon Kostantinis, Judit Karácsonyi, Salman Allana, Evan Walser-Kuntz, Bavana V. Rangan, Bahadir Simsek, Beatrice Rynders, Olga Mastrodemos, Larissa Stanberry, Vennela Avula, Athanasios Rempakos, M. Nicholas Burke, Yader Sandoval, M. Mooney, Paul Sorajja, Jay H. Traverse, Anil Poulose, Ivan Chavez, Yale Wong, Mario Gössl, Emmanouil S. Brilakis
Abstract
BACKGROUND: Coronary artery dissection is a feared and potentially life-threatening complication of percutaneous coronary intervention (PCI). METHODS: We examined the clinical, angiographic, and procedural characteristics, and outcomes of coronary dissection at a tertiary care institution. RESULTS: Between 2014 and 2019, unplanned coronary dissection occurred in 141 of 10,278 PCIs (1.4%). Median patient age was 68 (60, 78) years, 68% were men, and 83% had hypertension. The prevalence of diabetes (29%), and prior PCI (37%) was high. Most target vessels were significantly diseased: 48% had moderate/severe tortuosity and 62% had moderate/severe calcification. The most common cause of dissection was guidewire advancement (30%), followed by stenting (22%), balloon angioplasty (20%), and guide-catheter engagement (18%). TIMI flow was 0 in 33% and 1-2 in 41% of cases. Intravascular imaging was used in 17% of the cases. Stenting was used to treat the dissection in 73% of patients. There was no consequence of dissection in 43% of patients. Technical and procedural success was 65% and 55%, respectively. In-hospital major adverse cardiovascular events occurred in 23% of patients: 13 (9%) had an acute myocardial infarction (MI), 3 (2%) had emergency coronary artery bypass graft surgery, and 10 (7%) died. During a mean follow up of 1612 days, 28 (20%) patients died, and the rate of target lesion revascularization was 11.3% (n=16). CONCLUSION: Coronary artery dissection is an infrequent complication of PCI, but is associated with adverse clinical outcomes, such as death and acute MI.