In-hospital and mid-term outcomes of catheter-induced iatrogenic coronary artery dissection: a retrospective case-control study

BACKGROUND AND OBJECTIVES: Catheter-induced iatrogenic coronary artery dissection (CICAD) is a rare but catastrophic complication of coronary angiography and percutaneous coronary intervention (PCI). Data on its, management strategies, and mid-term outcomes remain scarce. This study aimed to evaluate the in-hospital and follow-up outcomes of CICAD and compare them with a contemporaneous control population. METHODS: This single-center retrospective case-control study included 55 consecutive patients who developed CICAD during coronary angiography or PCI between November 2023 and December 2025. A control group of 169 patients without dissection during the same period was randomly selected to achieve a 1 : 3 case-to-control ratio. The primary outcome was 1-month major adverse cardiac events (MACE), defined as the composite of all-cause death, myocardial infarction, and stroke. Six-month MACE was a prespecified exploratory secondary endpoint. RESULTS: In-hospital mortality was significantly higher in the CICAD group (16.4 vs. 1.2%; P < 0.001). All MACE in the CICAD group occurred within 30 days (1-month MACE: 29.1 vs. 6.5%; P < 0.001). Six-month MACE remained higher in the CICAD group (29.1 vs. 14.8%; P = 0.026). Kaplan-Meier analysis demonstrated a sharp decline in MACE-free survival in the CICAD group, with subsequent stabilization and a parallel trajectory with the control group (log-rank P = 0.023). Repeat revascularization at 6 months was higher in the CICAD group (29.1 vs. 2.4%; P < 0.001). CONCLUSION: CICAD carries a high burden of early mortality and morbidity, concentrated entirely within 30 days. Survivors achieve mid-term outcomes comparable to controls, suggesting aggressive early management may mitigate long-term risk.