Mauro Gitto, Pier Pasquale Leone, Francesco Gioia, Mauro Chiarito, Alessia Latini, Francesco Tartaglia, Ismail Dogu Kilic, Marco Luciano Rossi, Damiano Regazzoli, Gabriele Gasparini, Ottavia Cozzi, Alessandro Sticchi, Gianluigi Condorelli, Bernhard Reimers, Giulio Giuseppe Stefanini, Antonio Mangieri, Antonio Colombo
{"title":"Coronary Artery Dissection in Drug-Coated Balloon Angioplasty: Incidence, Predictors, and Clinical Outcomes.","authors":"Mauro Gitto, Pier Pasquale Leone, Francesco Gioia, Mauro Chiarito, Alessia Latini, Francesco Tartaglia, Ismail Dogu Kilic, Marco Luciano Rossi, Damiano Regazzoli, Gabriele Gasparini, Ottavia Cozzi, Alessandro Sticchi, Gianluigi Condorelli, Bernhard Reimers, Giulio Giuseppe Stefanini, Antonio Mangieri, Antonio Colombo","doi":"10.1016/j.amjcard.2024.12.008","DOIUrl":null,"url":null,"abstract":"<p><p>Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCB) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. The aim of this study was to evaluate incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease (CAD). Consecutive patients with de novo CAD undergoing PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at two Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter and persistent extra-luminal contrast hang-up. The primary endpoint at 2-year follow-up was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularization. Among 522 DCB-treated lesions in 466 patients, dissections were angiographically evident in 39.1% of lesions, with 21.1% undergoing bail-out stenting and 78.9% left untreated. Incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (OR 1.64, 95% CI: 1.12-2.39) was the strongest risk factors for dissection. TLF at 2-year occurred in 2.7% of lesions with untreated dissection compared to 4.2% of those with no dissection (log-Rank p =0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at mid-term follow-up.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjcard.2024.12.008","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCB) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. The aim of this study was to evaluate incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease (CAD). Consecutive patients with de novo CAD undergoing PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at two Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter and persistent extra-luminal contrast hang-up. The primary endpoint at 2-year follow-up was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularization. Among 522 DCB-treated lesions in 466 patients, dissections were angiographically evident in 39.1% of lesions, with 21.1% undergoing bail-out stenting and 78.9% left untreated. Incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (OR 1.64, 95% CI: 1.12-2.39) was the strongest risk factors for dissection. TLF at 2-year occurred in 2.7% of lesions with untreated dissection compared to 4.2% of those with no dissection (log-Rank p =0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at mid-term follow-up.
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.