Impact of catheter-induced iatrogenic coronary artery dissection with or without postprocedural flow impairment: A report from a Japanese multicenter percutaneous coronary intervention registry.

Yohei Numasawa,Keiichi Fukuda,Kouji Negishi,Shun Kohsaka,Shinsuke Yuasa,Yasuyuki Shiraishi,Kentaro Hayashida,Hiroaki Miyata,Shigetaka Noma,Ikuko Ueda,Mitsuaki Sawano,Yoshiaki Taniyama,Takahiro Hiraide,Takahiro Ohki

doi:10.1371/journal.pone.0204333

Abstract

Despite the ever-increasing complexity of percutaneous coronary intervention (PCI), the incidence, predictors, and in-hospital outcomes of catheter-induced coronary artery dissection (CICAD) is not well defined. In addition, there are little data on whether persistent coronary flow impairment after CICAD will affect clinical outcomes. We evaluated 17,225 patients from 15 participating hospitals within the Japanese PCI registry from January 2008 to March 2016. Associations between CICAD and in-hospital adverse cardiovascular events were evaluated using multivariate logistic regression. Outcomes of patients with CICAD with or without postprocedural flow impairment (TIMI flow ≤ 2 or 3, respectively) were analyzed. The population was predominantly male (79.4%; mean age, 68.2 ± 11.0 years); 35.6% underwent PCI for complex lesions (eg. chronic total occlusion or a bifurcation lesion.). CICAD occurred in 185 (1.1%), and its incidence gradually decreased (p < 0.001 for trend); postprocedural flow impairment was observed in 43 (23.2%). Female sex, complex PCI, and target lesion in proximal vessel were independent predictors (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.53–3.10; OR, 2.19; 95% CI, 1.58–3.04; and OR, 1.55; 95% CI, 1.06–2.28, respectively). CICAD was associated with an increased risk of in-hospital adverse events (composite of new-onset cardiogenic shock and new-onset heart failure) regardless of postprocedural flow impairment (OR, 10.9; 95% CI, 5.30–22.6 and OR, 2.27; 95% CI, 1.20–4.27, respectively for flow-impaired and flow-recovered CICAD). In conclusion, CICAD occurred in roughly 1% of PCI cases; female sex, complex PCI, and proximal lesion were its independent risk factors. CICAD was associated with adverse in-hospital cardiovascular events regardless of final flow status. Our data implied that the appropriate selection of PCI was necessary for women with complex lesions.

Highlights

In the pre-stent era, catheter-induced coronary artery dissection (CICAD) occurred in approximately 30% of cases during percutaneous coronary intervention (PCI) [1,2,3]
Between 2008 and 2016, CICAD occurred in 185 patients (1.1%) with the annual incidence gradually decreasing over time (p < 0.001 for trend) (Fig 2)
CICAD was more frequently observed in women than in men (34.3% vs 20.5%, p < 0.001)

Summary

Introduction

In the pre-stent era, catheter-induced coronary artery dissection (CICAD) occurred in approximately 30% of cases during percutaneous coronary intervention (PCI) [1,2,3]. With the arrival of bare metal and drug-eluting stents (DES), the incidence of CICAD decreased down to 2–3% in the early 2000s [4], with a majority of the cases achieving normal distal flow at final angiography owing to the advancement of various bailout techniques [5,6] This advancement has led more interventionists to perform PCI in patients with more high-risk anatomic features, such as chronic total occlusion (CTO), bifurcation, and left main trunk lesions [7]. There were several previously published series, their small size has limited the robustness of any conclusion; in particular, the impact of flow-limiting vs flow-recovered CICAD has not yet been defined The aim of this observational multicenter study was to assess the incidence, predictors, and in-hospital outcomes of CICAD. We hypothesized that the occurrence of CICAD may be related to a worse in-hospital outcome, more so in CICAD patients with coronary flow impairment (Thrombolysis in Myocardial Infarction [TIMI] flow 0–2)

Objectives

Methods

Results

Discussion

Conclusion