title: Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: an optical coherence tomography study.
abstract: OBJECTIVE
  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).
  
  
  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.affiliation: Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
authors.forename: Konstantina P
authors.initials: KP
authors.lastname: Bouki
authors.affiliation: Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Sakkali
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.affiliation: Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
authors.forename: Delia
authors.initials: D
authors.lastname: Vlad
authors.affiliation: Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Barmperis
authors.affiliation: Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Phychari
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Riga
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Apostolou
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology / Q000628:therapy*; D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D003331:Coronary Vessels / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: acute coronary syndrome; clinical outcome; optical coherence tomography; stent edge dissection