Safety and efficacy of drug eluting stents in patients with spontaneous coronary artery dissection.
OBJECTIVE
Given the different pathogenesis, use of drug eluting stent (DES) in patients with Spontaneous Coronary Artery Dissection SCAD may delay the healing of the dissected vessel. Aim of our study was to compare the safety and the efficacy of DES vs. bare metal stent (BMS) in a cohort of patients who underwent stenting for SCAD.


RESULTS
Consecutive patients with SCAD between January 1995 and August 2014 were retrospectively identified in 12 centers and included. Major Adverse Cardiac Events (MACE) was the primary end point. A total of 238 SCAD patients were identified: of them 108 patients underwent PCI with DES or BMS. Overall 24 patients (22.2%) suffered an intra-procedural complication without any differences between the 2 groups. At median follow-up of 1201days (Inter Quartile Range 541-2760), incidence of the primary endpoint showed a trend towards less events in the DES-treated patients (38.7% vs. 25.9% p=0.14) mainly driven by the benefit of DES in terms of TVR (17.6% vs. 4%, p=0.08), mortality (16.8% vs. 9.3%, p=0.4), and MI rate (16% vs. 8.4%, p=0.33). STEMI at presentation (HR 6.4, CI 95% 1.29-31.9, p=0.02) but not kind of stent (HR 0.97, CI 95% 0.2-4.7, p=0.9) emerged as independently related to prognosis at multivariable analysis.


CONCLUSIONS
In SCAD patients use of DES seems to be as safe as BMS with trend of better efficacy in the long term.
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: fconrotto@cittadellasalute.to.it.
Federico
F
Conrotto
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
Fabrizio
F
D'Ascenzo
Division of Cardiology, Rivoli Hospital, Rivoli, Italy.
Enrico
E
Cerrato
Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain.
Antonio
A
Fernández-Ortiz
Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain.
Nieves
N
Gonzalo
Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain.
Fernando
F
Macaya
Cardiology Department, Ferrarotto Hospital, Catania, Italy.
Corrado
C
Tamburino
Cardiology Department, Ferrarotto Hospital, Catania, Italy.
Marco
M
Barbanti
Amsterdam Medical Center, Amsterdam, The Netherlands.
Martijn
M
van Lavieren
Amsterdam Medical Center, Amsterdam, The Netherlands.
Jan J
JJ
Piek
Cardiology Department, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
Robert J
RJ
Applegate
San Raffaele Scientific Institute, Milan, Italy.
Azeem
A
Latib
Santa Croce Hospital, Moncalieri, Italy.
Maria Teresa
MT
Spinnler
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
Raffaella
R
Marzullo
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
Mario
M
Iannaccone
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
Marco
M
Pavani
Ospedale Villa Scassi, Genova, Italy.
Gabriele
G
Crimi
Ospedali Riuniti Marche Nord, Pesaro, Italy.
Rossella
R
Fattori
Maria Vittoria Hospital, Turin, Italy.
Alessandra
A
Chinaglia
Humanitas Research Hospital, Rozzano, Italy.
Patrizia
P
Presbitero
Division of Cardiology, Rivoli Hospital, Rivoli, Italy.
Ferdinando
F
Varbella
Cardiology Department. Città della Salute e della Scienza Hospital, Turin, Italy.
Fiorenzo
F
Gaita
Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain.
Javier
J
Escaned
D000328:Adult; D000368:Aged; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery