Circulation, Vol 83, 927-936, Copyright © 1991 by American Heart Association
PJ de Feyter, M van den Brand, GJ Laarman, R van Domburg, PW Serruys, H Suryapranata and GJ] Jaarman G$[corrected to Laarman
BACKGROUND. Acute coronary artery occlusion after percutaneous transluminal
coronary angioplasty (PTCA) continues to remain a serious complication
despite significant improvement in operator performance and technological
advancements. This retrospective study was performed to ascertain the
frequency, predictive variables, management, and outcome of acute coronary
artery occlusion. METHODS AND RESULTS. The study was based on data from
1,423 consecutive patients who underwent an elective coronary angioplasty
between January 1986 and December 1988. Acute coronary artery occlusion
occurred in 104 patients (7.3%). Acute occlusion developed during the
dilatation procedure in 80 patients (5.6%) and within 24 hours after the
procedure in 24 patients (1.7%). Four clinical and 14 angiographic
variables predictive for acute coronary artery occlusion were analyzed in
these 104 patients with a complicated procedure and were compared with
those in 104 representative patients with successful attempts. Multivariate
analysis found three independent predictive variables: unstable angina,
multivessel disease, and complex lesions. The overall clinical outcome
after management of acute coronary artery occlusion including immediate
repeat dilatation (95 patients), use of intracoronary streptokinase (34
patients), or autoperfusion catheter (12 patients) was successful
(reduction of lumen diameter to less than 50%, no death, no myocardial
infarction [MI], and no emergency surgery) in 42 patients (40%), was a
failure without major complication in four patients (4%), and was a failure
with major complication (death, MI, and emergency surgery) in 58 patients
(56%). The overall mortality rate was 6% (six patients), the overall MI
rate was 36% (37 patients), and emergency bypass surgery was required in
30% of patients (31 patients). At 6 months' follow-up of 42 patients with
successful management, recurrent angina pectoris due to restenosis occurred
in 10 patients (24%), and a late MI occurred in one patient (3%). At 6
months' follow-up of 56 survivors with unsuccessful management (development
of MI or need for emergency bypass surgery), recurrent angina occurred in
nine patients (16%), and cardiac death in two patients (4%). However, the
majority of patients in both groups were either symptom free or had mild
angina pectoris. CONCLUSION. Acute coronary artery occlusion during PTCA is
often unpredictable, but its frequency is higher in patients with unstable
angina, multivessel disease, and complex lesions. Despite immediate
redilatation, use of intracoronary streptokinase, and emergency bypass
surgery, PTCA is associated with a high mortality and morbidity.
ARTICLES
Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up [published erratum appears in Circulation 1991 Jul;84(1):446]
Catheterization Laboratory, Erasmus University, Rotterdam, The Netherlands.
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