title: Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation.
abstract: OBJECTIVE
  Coronary dissections left untreated after percutaneous coronary intervention are associated with unfavourable outcomes. However, their role after drug-eluting stent (DES) implantation is still undescribed. We assessed incidence, predictors, and outcomes of residual dissections in DES-treated lesions.
  
  
  RESULTS
  Consecutive patients undergoing DES implantation were enrolled in four Italian centres, with baseline, procedural, and outcome data entered into a dedicated database. Residual dissections were classified according to the National Heart Lung and Blood Institute criteria. End-points of interest were in-hospital, 1-month, and 6-month major adverse cardiovascular events (MACE, i.e. death, myocardial infarction, or target vessel revascularization), and stent thrombosis (ST). Among the 2418 included patients (4630 lesions), a total of 77 (1.7%) final dissections occurred in 67 (2.8%) subjects. Dissections were more frequent in longer and complex lesions and in the left anterior descending, and were associated with increased rates of in-hospital (11.9 vs. 5.2%, P=0.017) and 1-month MACE (13.4 vs. 6.0%, P=0.013), with similar 6-month trends. Cumulative ST was also greater in patients with dissections (6.3 vs. 1.3%, P=0.011). Even non-obstructive dissections with thrombolysis in myocardial infarction 3 flow conferred a significantly worse prognosis.
  
  
  CONCLUSIONS
  This study, reporting for the first time on incidence, predictors, and outcomes of residual dissections in DES-treated coronary lesions, demonstrates their adverse clinical impact and supports the pursuit of a strategy of sealing dissection flaps with other DES.
authors.affiliation: Interventional Cardiology Unit, St Raffaele Hospital, Milan, Italy.
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Rossella
authors.initials: R
authors.lastname: Barbagallo
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Guido
authors.initials: G
authors.lastname: Vittori
authors.forename: Elena
authors.initials: E
authors.lastname: Falchetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Enrico
authors.initials: E
authors.lastname: Remigi
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000784:Aortic Dissection / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000379:methods*; D001807:Blood Vessel Prosthesis; D003323:Coronary Aneurysm / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004343:Drug Implants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011475:Prosthesis Failure; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D004343:Drug Implants