Angiographic and clinical outcome of mild to moderate nonocclusive unstented coronary artery dissection and the influence on coronary flow velocity reserve
M. Albertal et al., Angiographic and clinical outcome of mild to moderate nonocclusive unstented coronary artery dissection and the influence on coronary flow velocity reserve, AM J CARD, 86(4), 2000, pp. 375-378
Citations number
16
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Limited data ore available regarding the angiographic healing rate and phys
iologic impact of coronary artery dissections. Therefore, we studied the im
pact of coronary dissections on coronary flow velocity and outcome as well
as their healing rate at 6-month follow-up balloon angioplasty. Of 297 pati
ents who underwent balloon angioplasty, 225 underwent intracoronary Doppler
measurements and 184 had Doppler and angiographic assessment at 6-month fo
llow-up. Dissections were scored by an independent core lab (Cardialysis BV
) and divided in 4 groups: mild (types A to B), moderate (type C), severe (
D to F), and patients without dissections. Severe dissections (types D to F
) were excluded from the analysis. Clinical, angiographic, and Doppler data
were compared among the remaining 3 patient groups. From the 67 dissection
s detected after balloon angioplasty, only 3 (4.5%) remained unhealed at fo
llow-up. Immediately after balloon angioplasty, the moderate dissection gro
up was associated with a lower coronary flow velocity reserve than the pati
ents with mild (2.16 +/- 0.60 vs 2.82 +/- 1.00, p = 0.037) or no dissection
s (2.16 a 0.60 vs 2.71 +/- 0.88, p = 0.046), respectively. In addition, hig
her recurrence of angina at 30 days was observed in the moderate group rath
er than in the mild group (5 [50%] vs 8 [16%], p = 0.0160) and in the patie
nts without dissections (11 [12%], p = 0.007). After standard balloon angio
plasty, the occurrence of unhealed dissections is a rare phenomenon. An imp
aired coronary flow reserve was observed after the development of nonocclus
ive type C dissections, which was associated with a worse short-term outcom
e. (C) 2000 by Excerpta Medico, Inc.