Early outcome of coronary dissections following PTCA

Background: Coronary dissection is the major complication of PTCA which could potentially result in abrupt coronary closure. We hypothesize that different types of the dissections carry different clinical prognosis. Method: One hundred and five patients who underwent relook coronary angiography within 24 hours of PTCA were selected from 2386 cases of the PTCA. Dissections were classified by NHLBI criteria. Percentage of stenosis, minimal luminal diameter and length of dissections at the end of PTCA were compared with those at the relook angiography. Patients clinical events (abrupt closure, chest pain with ST changes, bypass, rePTCA, stent implantation) were recorded. Results: The results showed that the type C + E, E and D dissections carry adverse outcome with worsening of stenosis and minimal luminal diameter, and increased rate of ischemic events and clinical interventions. However, the type C, B and A dissections were relatively stable. Conclusion: Clinical intervention is seldom neccessary for type A, B and C dissections. However, consideration for bypass operation or stenting must be given to type C + E, E and D due to high chance of unfavourable outcome.