Iatrogenic catheter‐induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55, 968 patients over 10 years. Issue 4 (25th November 2020)

• Record Type: Journal Article
• Authors: Ramasamy, Anantharaman; Bajaj, Retesh; Jones, Daniel A; Amersey, Rajiv; Mathur, Anthony; Baumbach, Andreas; Bourantas, Christos V.; O'Mahony, Constantinos
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 4(2021)
• Page Start: 649
• Page End: 655
• Publication Date: 2020-11-25
• Subjects: angiography -- complications -- coronary aneurysm/dissection/perforation -- coronary -- diagnostic catheterization -- percutaneous coronary intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29382
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: 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.