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

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.