Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: an optical coherence tomography study.

Abstract

AIMS:

The purpose of the present study was to assess the incidence, predictors and long term prognosis of stent edge dissections identified by (OCT) after the implantation of bare metal (BMS) and drug eluting stents (DES).

METHODS AND RESULTS:

We studied 74 patients who underwent percutaneous coronary intervention (PCI) because of an acute coronary syndrome. Edge dissections were found in 29 of 74 patients (39.1%). Independent predictors of edge dissections were: the presence of ST-elevation myocardial infarction (STEMI) (P = 0.005, odds ratio 11.78; 95% Cl 2.06-67.10), the small reference lumen diameter (P = 0.009, odds ratio 0.11; 95% Cl 0.02-0.58) and the short stents implanted (P = 0.013, odds ratio 0.83; 95% Cl 0.72-0.96). During a follow-up period of 25.6 ± 9.4 months 11 patients presented with at least one major adverse cardiac event. Event free survival was significantly decreased in patients with edge dissection with a flap thickness >0.31 mm compared to patients with thinner flap or without any dissection (P < 0.001).

CONCLUSIONS:

OCT frequently detects edge dissections, usually related to STEMI presentation and to PCI technique. Deep vessel wall injury at stent edges with a dissection flap thickness more than 0.31mm carries an adverse clinical impact on long-term clinical outcome.

• Authors: Konstantina P Bouki, Eleni Sakkali, Konstantinos Toutouzas, Delia Vlad, Dimitrios Barmperis, Stavroula Phychari, Maria Riga, Thomas Apostolou, Christodoulos Stefanadis
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 86 Issue 2 Pg. 237-46 (Aug 2015) ISSN: 1522-726X [Electronic] United States
• PMID: 25620191 (Publication Type: Journal Article)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Acute Coronary Syndrome (pathology, therapy)
• Aged
• Area Under Curve
• Chi-Square Distribution
• Coronary Vessels (pathology)
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (pathology, therapy)
• Odds Ratio
• Percutaneous Coronary Intervention (adverse effects, instrumentation)
• Predictive Value of Tests
• Prospective Studies
• Prosthesis Design
• ROC Curve
• Risk Factors
• Stents
• Time Factors
• Tomography, Optical Coherence
• Treatment Outcome