Circulation, Vol 82, 739-750, Copyright © 1990 by American Heart Association
KM Detre, DR Holmes Jr, R Holubkov, MJ Cowley, MG Bourassa, DP Faxon, GR Dorros, LG Bentivoglio, KM Kent and RK Myler
Of 1,801 patients in the 1985-1986 Percutaneous Transluminal Coronary
Angioplasty (PTCA) Registry, 122 (6.8%) had periprocedural occlusion (4.9%
in the catheterization laboratory, 1.9% outside the laboratory). Baseline
patient factors independently associated with increased occlusion rates
included triple-vessel disease, high risk status for surgery, and acute
coronary insufficiency. Lesion characteristics showing significant positive
association included severe stenosis before PTCA, diffuse or multiple
discrete morphology, thrombus, and collateral flow from the lesion. Intimal
tear and dissection were also very strongly associated with occlusion.
Sixty patients (49%) had a transient occlusion that was reopened with PTCA,
43 (35%) were not redilated and managed with bypass surgery, and 19 (16%)
were not redilated and managed medically. In-hospital mortality was 5% in
each of these treatment groups, compared with 1% in occlusion-free
patients. In-hospital infarction rates ranged from 27% in patients with
transient occlusion to 56% in the patients managed with surgery, compared
with 2% in patients without occlusion. During 2 years of follow-up,
somewhat increased mortality continued in patients with occlusion, whereas
follow-up infarction rates were comparable for all patients regardless of
occlusion. Patients with an occlusion that was reopened or managed
medically had increased rates of surgery during follow-up. Rates of repeat
PTCA were comparable (about 23% by 2 years) in patients with transient
occlusion and those without occlusion. Occlusion remains a serious
complication of angioplasty and is associated most strongly with major
events and surgical procedures that occur during the in- hospital period.
ARTICLES
Incidence and consequences of periprocedural occlusion. The 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
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