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Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting
M Albertal1, G Van Langenhove, E Regar
1Hartcentrum Rotterdam, University Hospital Dijkzigt-Thoraxcenter Bd 408, Dr Molewaterplein, 40-3015GD Rotterdam, Netherlands.
Insights
Moderate coronary dissections after angioplasty do not increase adverse cardiac events if left untreated. Stenting these dissections does not improve long-term outcomes compared to no further treatment.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
Background:
- Coronary artery dissection is a complication of balloon angioplasty.
- The impact of moderate dissections on long-term outcomes requires further investigation.
Purpose of the Study:
- To assess the relationship between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long-term clinical outcomes.
- To evaluate the effect of stenting on outcomes in patients with moderate coronary dissections.
Main Methods:
- A total of 256 patients from the DEBATE II trial with moderate coronary dissections (Type C) after balloon angioplasty were analyzed.
- Patients were randomized to receive stenting or no further treatment.
- Coronary flow velocity reserve (CFVR) was measured, and major adverse cardiac events were tracked over 12 months.
Main Results:
- No significant difference in CFVR was observed between groups with or without moderate dissections post-angioplasty.
- Patients with moderate dissections who received stenting had a higher risk of major adverse cardiac events compared to those not stented (OR 6.603, p=0.046).
- Untreated moderate dissections did not lead to a significantly increased risk of major adverse cardiac events at 12 months.
Conclusions:
- Moderate coronary dissections following balloon angioplasty, when left untreated, do not appear to increase the risk of major adverse cardiac events.
- The addition of stenting in cases of moderate coronary dissections does not improve long-term clinical outcomes and may increase adverse events.
Objective:
To study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome.
Methods:
523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler endpoints balloon angioplasty trial Europe). After successful balloon angioplasty, patients were randomised to stenting or no further treatment. Dissections were graded at the core laboratory by two observers and divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients were divided into two groups according to the presence (group A, n = 45) or absence (group B, n = 211) of moderate dissection.
Results:
Following balloon angioplasty, there was no difference in CFVR between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%) v 23 (11%), p = 0.041). However, the risk of major adverse events was similar in the subgroups receiving balloon angioplasty (group A, 6 (19%) v group B, 16 (16%), NS). Among group A patients, the adverse events risk was greater in those randomised to stenting (odds ratios 6.603 v 1.197, p = 0.046), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or >/= 2.5 after balloon angioplasty.
Conclusions:
Moderate dissections left untreated result in no increased risk of major adverse cardiac events. Additional stenting does not improve the long term outcome.