Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty

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Circulation. 1988;77:372-379

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ARTICLES

Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty

SG Ellis, GS Roubin, SB King 3d, JS Douglas Jr, WS Weintraub, RG Thomas and WR Cox
Andreas Gruentzig Cardiovascular Center, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322.

To determine predictors of acute coronary closure after PTCA performed with steerable catheter systems, we compared 140 procedures complicated by acute closure and 311 representative successful attempts from 4,772 procedures performed between April 1982 and March 1986. Sixteen clinical, 35 angiographic, and seven procedural variables were analyzed. Multivariate analysis found seven independent preprocedural factors related to closure: stenosis length of 2 or more luminal diameters, female gender, stenosis at a bend point of 45 degrees or more, stenosis at a branch point, stenosis-associated thrombus (filling defect or staining), other stenoses in the same vessel, and multivessel disease. In addition, four procedural factors were found to be associated with closure by univariate analysis: post-PTCA percent stenosis (p less than .001), intimal tear or dissection (p less than .001), use of prolonged heparin infusion (p less than .001), and post- PTCA gradient of 20 mm Hg or more (p = .004). Multivariate analysis of both preprocedural and procedural variables found six factors independently related to closure: post-PTCA percent stenosis, dissection, prolonged post-PTCA use of heparin, branch point location, fixed bend point location, and other stenoses in the vessel dilated. The risk of coronary closure after PTCA has many determinants. While an estimation of risk can be made before performing PTCA, the most powerful predictors of closure can only be assessed during the procedure itself.

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				J.-i. Kotani, G. S. Mintz, P. B. Rai, C. K. Pappas, N. Gevorkian, A. B. Bui, A. D. Pichard, L. F. Satler, W. O. Suddath, R. Waksman, et al. Intravascular ultrasound assessment of angiographic filling defects in native coronary arteries: Do they always contain thrombi? J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2087 - 2089. [Full Text] [PDF]

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				P. W. Serruys, D. P. Foley, M.-J. Suttorp, B. J. W. M. Rensing, H. Suryapranata, P. Materne, A. van den Bos, E. Benit, A. Anzuini, W. Rutsch, et al. A randomized comparison of the value of additional stenting after optimal balloon angioplasty for long coronary lesions: Final results of the additional value of nir stents for treatment of long coronary lesions (ADVANCE) study J. Am. Coll. Cardiol., February 6, 2002; 39(3): 393 - 399. [Abstract] [Full Text] [PDF]

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				A. Segev, D. Aviezer, M. Safran, Z. Gross, and A. Yayon Inhibition of vascular smooth muscle cell proliferation by a novel fibroblast growth factor receptor antagonist Cardiovasc Res, January 1, 2002; 53(1): 232 - 241. [Abstract] [Full Text] [PDF]

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				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

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				N. S. Kleiman, A. M. Lincoff, G. C. Flaker, K. S. Pieper, R. G. Wilcox, L. G. Berdan, T. J. Lorenz, D. V. Cokkinos, M. L. Simoons, E. Boersma, et al. Early Percutaneous Coronary Intervention, Platelet Inhibition With Eptifibatide, and Clinical Outcomes in Patients With Acute Coronary Syndromes Circulation, February 22, 2000; 101(7): 751 - 757. [Abstract] [Full Text] [PDF]

				W. S. Weintraub, S. Culler, S. J. Boccuzzi, J. R. Cook, A. S. Kosinski, D. J. Cohen, J. Burnette, and for the RESTORE Trial Study Group Economic impact of GPIIB/IIIA blockade after high-risk angioplasty: Results from the restore trial J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1061 - 1066. [Abstract] [Full Text] [PDF]

				A. Kini, J. D. Marmur, S. Kini, G. Dangas, T. P. Cocke, S. Wallenstein, E. Brown, J. A. Ambrose, and S. K. Sharma Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course: Implications for early discharge after coronary intervention J. Am. Coll. Cardiol., September 1, 1999; 34(3): 663 - 671. [Abstract] [Full Text] [PDF]

				H. Schunkert, L. Harrell, and I. F. Palacios Implications of small reference vessel diameter in patients undergoing percutaneous coronary revascularization J. Am. Coll. Cardiol., July 1, 1999; 34(1): 40 - 48. [Abstract] [Full Text] [PDF]

				Th. Budde, M. Haude, H.W. Hopp, S. Kerber, G. Caspari, G. Fassbender, M. Fingerhut, I. Novopashenny, Y. Ogurol, G. Breithardt, et al. A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project Eur. Heart J., March 1, 1999; 20(5): 354 - 363. [Abstract] [PDF]

				R. N. Piana, W. H. Ahmed, B. Chaitman, P. Ganz, S. Kinlay, J. Strony, B. Adelman, J. A. Bittl, and on behalf of the Hirulog Angioplasty Study Investi Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months J. Am. Coll. Cardiol., January 1, 1999; 33(1): 73 - 78. [Abstract] [Full Text] [PDF]

				S. G. Ellis, A. M. Lincoff, D. Miller, J. E. Tcheng, N. S. Kleiman, D. Kereiakes, R. Califf, E. J. Topol, and for the EPIC and EPILOG Investigators Reduction in complications of angioplasty with abciximab occurs largely independently of baseline lesion morphology J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1619 - 1623. [Abstract] [Full Text] [PDF]

				I. Eisensehr, B. L. Ehrenberg, S. Noachtar, K. Korbett, A. Byrne, A. McAuley, and T. Palabrica Platelet activation, epinephrine, and blood pressure in obstructive sleep apnea syndrome Neurology, July 1, 1998; 51(1): 188 - 195. [Abstract] [Full Text] [PDF]

				R. Kornowski, R. Mehran, M. K. Hong, L. F. Satler, A. D. Pichard, K. M. Kent, G. S. Mintz, R. Waksman, J. R. Laird, A. J. Lansky, et al. Procedural Results and Late Clinical Outcomes After Placement of Three or More Stents in Single Coronary Lesions Circulation, April 14, 1998; 97(14): 1355 - 1361. [Abstract] [Full Text] [PDF]

				M. J. Vonesh, L. F. Mockros, C. J. Davidson, K. B. Chandran, and D. D. McPherson In Vitro Identification of Angioplasty-Induced Injury by Use of Vascular Acoustic Emissions Circulation, February 18, 1997; 95(4): 1022 - 1029. [Abstract] [Full Text]

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