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Predictors of coronary dissection following percutaneous transluminal coronary balloon angioplasty
1Section of Cardiovascular Medicine, Yale University, School of Medicine, New Haven, Conn.
Insights
Coronary dissection during angioplasty is common, especially in women and with long lesions. While frequent, most dissections do not lead to complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary angioplasty is a common procedure for treating coronary artery disease.
- Coronary dissection is a known complication of angioplasty, but its predictors and impact require further elucidation.
Purpose of the Study:
- To identify predictors of acute coronary dissection following coronary angioplasty.
- To assess the complications associated with coronary dissection during angioplasty.
Main Methods:
- A retrospective study of 170 consecutive patients undergoing 234 arterial dilatations.
- Analysis of patient demographics, lesion characteristics, and procedural parameters.
- Comparison of dissection rates and complication frequencies between patient groups.
Main Results:
- Coronary dissection occurred in 44% of treated arteries.
- Dissections were more frequent in women (55%) and patients with long lesions (61%).
- Higher balloon-to-artery diameter ratios were associated with dissection. Non-Q wave myocardial infarctions were more frequent in patients with dissection.
Conclusions:
- Coronary dissection during angioplasty is relatively frequent but often not associated with severe complications.
- Female sex, long lesions, and higher balloon-to-artery ratios are predictors of coronary dissection.
- Most dissections do not result in adverse outcomes, but careful patient selection and procedural technique are warranted.
Abstract:
To determine predictors of acute coronary dissection after coronary angioplasty, we studied 170 consecutive patients who underwent arterial dilatations of 234 arteries. Coronary dissection occurred in 103 (44%) arteries. More dissections occurred in women [40/73 (55%) versus 63/161 (39%), p < 0.03] and in patients with long lesions [45/74 (61%) versus 56/158 (35%), p < 0.0005]. Balloon/arterial diameter ratio was higher in patients with dissection (1.1 +/- 0.2 versus 1.0 +/- 0.2, p < 0.02). Complications did not differ in patients with and without dissection except for non-Q wave myocardial infarctions which were more frequent in patients with coronary dissection [10/12 (83%) versus 2/12 (17%), p < 0.01]. Thus coronary dissection during angioplasty is relatively frequent. However, most dissections are not associated with complications. Balloon dilatation of lesions in female patients and in patients with long lesions are more likely to result in dissection.