Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan.
PLoS One. 2018 Sep 28;13(9):e0204333. doi: 10.1371/journal.pone.0204333. eCollection 2018.
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.
尽管经皮冠状动脉介入治疗（PCI）的复杂性不断增加，但导管相关冠状动脉夹层（CICAD）的发生率、预测因素和院内结局尚不清楚。此外，关于 CICAD 后持续的冠状动脉血流受损是否会影响临床结局的数据也很少。我们评估了 2008 年 1 月至 2016 年 3 月来自日本 PCI 注册研究的 15 家参与医院的 17225 例患者。使用多变量逻辑回归评估 CICAD 与院内不良心血管事件之间的关系。分析了 CICAD 患者与无术后血流受损患者（分别为 TIMI 血流≤2 或 3）的结局。该人群主要为男性（79.4%；平均年龄 68.2±11.0 岁）；35.6%因复杂病变（如慢性完全闭塞或分叉病变）行 PCI。185 例（1.1%）发生 CICAD，其发生率逐渐下降（趋势 p<0.001）；术后 43 例（23.2%）存在血流受损。女性、复杂 PCI 和靶病变位于近端血管是独立的预测因素（比值比[OR]，2.18；95%置信区间[CI]，1.53-3.10；OR，2.19；95%CI，1.58-3.04；OR，1.55；95%CI，1.06-2.28）。无论术后血流受损情况如何，CICAD 与院内不良事件（新发心源性休克和新发心力衰竭的复合事件）风险增加相关（血流受损和血流恢复的 CICAD 分别为 OR，10.9；95%CI，5.30-22.6 和 OR，2.27；95%CI，1.20-4.27）。总之，PCI 中约有 1%发生 CICAD；女性、复杂 PCI 和近端病变是其独立危险因素。CICAD 与不良院内心血管事件相关，与最终血流状态无关。我们的数据表明，对于患有复杂病变的女性，应选择适当的 PCI。
