Iatrogenic catheter-induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years.

Autor: Ramasamy A; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK., Bajaj R; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK., Jones DA; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK., Amersey R; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK., Mathur A; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK., Baumbach A; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK., Bourantas CV; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK.; Institute of Cardiovascular Sciences, University College London, London, UK., O'Mahony C; Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.; Institute of Cardiovascular Sciences, University College London, London, UK.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2021 Oct; Vol. 98 (4), pp. 649-655. Date of Electronic Publication: 2020 Nov 25.
DOI: 10.1002/ccd.29382
Abstrakt: Objective: We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter-induced ostial coronary artery dissection (ICOCAD).
Background: ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death.
Methods: 55,968 patients who underwent coronary angiography over a 10-year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all-cause mortality were retrieved from local and national databases.
Results: The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two-thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow-up of 3.6 years.
Conclusions: ICOCAD is a rare but life-threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.
(© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz: