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. 2001 Aug;86(2):193–198. doi: 10.1136/heart.86.2.193

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

M Albertal 1, G Van Langenhove 1, E Regar 1, I Kay 1, D Foley 1, G Sianos 1, K Kozuma 1, T Beijsterveldt 1, S Carlier 1, J Belardi 1, E Boersma 1, J Sousa 1, B de Bruyne 1, P Serruys 1
PMCID: PMC1729873  PMID: 11454840

Abstract

OBJECTIVE—To study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome.
METHODS—523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler 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 divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients 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 between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%) v 23 (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), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or ⩾ 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.


Keywords: coronary dissection; intracoronary Doppler; angioplasty

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Figure 1  .

Figure 1  

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Study population. All patients allocated to the guided balloon angioplasty group of the DEBATE II trial who did not require bail out stenting formed the population for our substudy (395 patients). Of these, 139 had no data of the reference vessel coronary flow velocity reserve available and were therefore excluded from further analysis. The remaining 256 patients underwent a second randomisation to additional stenting or termination of the procedure. We analysed these patients depending on the presence (group A) or absence (group B) of uncomplicated "moderate" dissections.

Figure 2  .

Figure 2  

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Baseline (b-APV) and hyperaemic (h-APV) average peak velocities before and after the procedure in group A and group B. Upper panels show the subgroup randomised to stopping the procedure after balloon angioplasty (BA); lower panels show the subgroup randomised to further stent implantation (stent).

Selected References

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