Angiographic and clinical outcome of mild to moderate nonocclusive unstented coronary artery dissection and the influence on coronary flow velocity reserve

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.