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document
Uncomplicated moderate coronary artery dissections after balloon angioplasty : good outcome without stenting . OBJECTIVE To study the relation between moderate coronary dissections , coronary flow velocity reserve ( CFVR ) , and long term outcome . METHODS 523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial ( Doppler endpoints balloon angioplasty trial Europe ) . After successful balloon angioplasty , patients were randomised to stenting or no further treatment . Dissections were graded at the core laboratory by two observers and divided into four categories : none , mild ( type A-B ) , moderate ( type C ) , severe ( types D to F ) . Patients with severe dissections ( n = 128 ) or without available reference vessel CFVR ( n = 139 ) were excluded . The remaining 256 patients were divided into two groups according to the presence ( group A , n = 45 ) or absence ( group B , n = 211 ) of moderate dissection . RESULTS Following balloon angioplasty , there was no difference in CFVR between the two groups . At 12 months follow up , a higher rate of major adverse cardiac events was observed overall in group A than in group B ( 10 ( 22 % ) v 23 ( 11 % ) , p = 0.041 ) . However , the risk of major adverse events was similar in the subgroups receiving balloon angioplasty ( group A , 6 ( 19 % ) v group B , 16 ( 16 % ) , NS ) . Among group A patients , the adverse events risk was greater in those randomised to stenting ( odds ratios 6.603 v 1.197 , p = 0.046 ) , whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or > /= 2.5 after balloon angioplasty . CONCLUSIONS Moderate dissections left untreated result in no increased risk of major adverse cardiac events . Additional stenting does not improve the long term outcome .
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Intervention_Physical
stenting
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Intervention_Surgical
.
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Intervention_Physical
balloon angioplasty
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Intervention_Physical
balloon angioplasty
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Intervention_Physical
stenting
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Intervention_Control
or no further treatment
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Outcome_Physical
CFVR
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Outcome_Adverse-effects
major adverse cardiac events
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Outcome_Adverse-effects
risk of major adverse events
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Outcome_Adverse-effects
adverse events risk
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Outcome_Adverse-effects
risk of major adverse cardiac events
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Participant_Sample-size
523
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Participant_Condition
balloon angioplasty and sequential intracoronary Doppler measurements
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Participant_Sample-size
256 patients