Coronary dissection during diagnostic angiography: long term outcome after emergency myocardial revascularization

Objective: Acute coronary dissection during diagnostic angiography requires immediate surgical intervention. In this study, we report our outcome in emergency myocardial revascularization in patients after iatrogenic coronary dissection.

Method: From August 2000 to March 2006, 16 patients with acute coronary dissection following diagnostic coronary angiography underwent urgent myocardial revascularization. Ages ranged from 43 to 82 years (61±12.3, 31% female). Dissection was found in the left main coronary in 63% of patients and also involved the LAD in 44% and the circumflex branch in 38% of patients. The right coronary was affected in 6%. Upon arrival in the operating room 44% of patients where in cardiogenic shock. Course and length of hospitalization, laboratory markers of myocardial infarction, clinical follow-up, complications and mortality were analyzed.

Results: Patients received an average of 2.8 coronary bypass grafts, a mammarian artery was used in 69% of cases. Mean time from dissection to start of operation was 204±135min (84–515min) Mean cardiopulmonary bypass time was 86±41min (37–202min), mean aortic cross clamp time was 39±17min (19–80min). Perioperative troponin I averaged at 42.4±90.5µmol/l (0.81–225µmol/l). ICU stay was 4.7±4.7 days, hospitalization 11.5±3.5 days. There was one early perioperative death. Mean post-operative follow-up was 21±20 month. One patient died 32 days after postoperatively.

Conclusion: Emergency myocardial revascularization after coronary dissection can be performed with good postoperativ morbidity and mortality and excellent results during follow up. Despite a high percentage of patients with preoperative hemodynamic compromise, results were encouraging and the operative strategy seems advisable especially in patients with cardiogenic shock.