Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting

Objective-To study the relation between moderate coronary dissections, coro nary flow velocity reserve (CFVR), and long term outcome. Methods-523 patients undergoing balloon angioplasty and sequential intracor onary Doppler measurements were examined as part of the DEBATE II trial (Do ppler 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 divide d into four categories: none, mild (type A-B), moderate (type C), severe (t ypes D to F). Patients with severe dissections (n = 128) or without availab le reference vessel CFVR (n = 139) were excluded. The remaining 256 patient s 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 betwe en the two groups. At 12 months follow up, a higher rate of major adverse c ardiac events was observed overall in group A than in group B (10 (22%) v 2 3 (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), wh ereas there was no difference in risk if the group was analysed according t o whether the CFVR was < 2.5 or greater than or equal to 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.