Circulation, Vol 82, 1193-1202, Copyright © 1990 by American Heart Association
SG Ellis, MG Vandormael, MJ Cowley, G DiSciascio, U Deligonul, EJ Topol and TM Bulle
To assess the likelihood of procedural success in patients with multivessel
coronary disease undergoing percutaneous coronary angioplasty, 350
consecutive patients (1,100 stenoses) from four clinical sites were
evaluated. Eighteen variables characterizing the severity and morphology of
each stenosis and 18 patient-related variables were assessed at a core
angiographic laboratory and at the clinical sites. Most patients had
Canadian Cardiovascular Society class III or IV angina (72%) and two-vessel
coronary disease (78%). Left ventricular function was generally well
preserved (mean ejection fraction, 58 +/- 12%; range, 18-85%) and 1.9 +/-
1.0 stenoses per patient had attempted percutaneous coronary angioplasty.
Procedural success (less than or equal to 50% final diameter stenosis in
one or more stenoses and no major ischemic complications) was achieved in
290 patients (82.8%), and an additional nine patients (2.6%) had a
reduction in diameter stenosis by 20% or more with a final diameter
stenosis 51-60% and were without major complications. Major ischemic
complications (death, myocardial infarction, or emergency bypass surgery)
occurred in 30 patients (8.6%). In-hospital mortality was 1.1%. Stepwise
regression analysis determined that a modified American College of
Cardiology/American Heart Association Task Force (ACC/AHA) classification
of the primary target stenosis (with type B prospectively divided into type
B1 [one type B characteristic] and type B2 [greater than or equal to two
type B characteristics]) and the presence of diabetes mellitus were the
only variables independently predictive of procedural outcome (target
stenosis modified ACC/AHA score; p less than 0.001 for both success and
complications; diabetes mellitus: p = 0.003 for success and p = 0.016 for
complications). Analysis of success and complications on a per stenosis
dilated basis showed, for type A stenoses, a 92% success and a 2%
complication rate; for type B1 stenoses, an 84% success and a 4%
complication rate; for type B2 stenoses, a 76% success and a 10%
complication rate; and for type C stenoses, a 61% success and a 21%
complication rate. The subdivision into types B1 and B2 provided
significantly more information in this clinically important intermediate
risk group than did the standard ACC/AHA scheme. The stenosis
characteristics of chronic total occlusion, high grade (80-99% diameter)
stenosis, stenosis bend of more than 60 degrees, and excessive tortuosity
were particularly predictive of adverse procedural outcome. This improved
scheme may improve clinical decision making and provide a framework on
which to base meaningful subgroup analysis in randomized trials assessing
the efficacy of percutaneous coronary angioplasty.
ARTICLES
Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group
Division of Cardiology, University of Michigan Medical Center, Ann Arbor 48109-0022.
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A L Gaster, U Slothuus Skjoldborg, J Larsen, L Korsholm, C von Birgelen, S Jensen, P Thayssen, K E Pedersen, and T H Haghfelt Continued improvement of clinical outcome and cost effectiveness following intravascular ultrasound guided PCI: insights from a prospective, randomised study Heart, September 1, 2003; 89(9): 1043 - 1049. [Abstract] [Full Text] [PDF] |
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F Airoldi, C Di Mario, G Stankovic, C Briguori, M Carlino, A Chieffo, F Liistro, M Montorfano, P Pagnotta, V Spanos, et al. Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery Heart, September 1, 2003; 89(9): 1050 - 1054. [Abstract] [Full Text] [PDF] |
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J. Mehilli, A. Kastrati, H. Bollwein, A. Dibra, H. Schuhlen, J. Dirschinger, and A. Schomig Gender and restenosis after coronary artery stenting Eur. Heart J., August 2, 2003; 24(16): 1523 - 1530. [Abstract] [Full Text] [PDF] |
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S. H. Wilson, P. Fasseas, J. L. Orford, R. J. Lennon, T. Horlocker, N. E. Charnoff, S. Melby, and P. B. Berger Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting J. Am. Coll. Cardiol., July 16, 2003; 42(2): 234 - 240. [Abstract] [Full Text] [PDF] |
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K. Kwon, D. Choi, S.-H. Choi, Bon Kwon Koo, Y. Jang, W.-H. Shim, and S.-Y. Cho Coronary Stenting After Rotational Atherectomy in Diffuse Lesions of the Small Coronary Artery: Comparison with Balloon Angioplasty Before Stenting Angiology, July 1, 2003; 54(4): 423 - 431. [Abstract] [PDF] |
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F Larrazet, A Dibie, F Philippe, R Palau, R Klausz, and F Laborde Factors influencing fluoroscopy time and dose-area product values during ad hoc one-vessel percutaneous coronary angioplasty Br. J. Radiol., July 1, 2003; 76(907): 473 - 477. [Abstract] [Full Text] [PDF] |
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W. Koch, J. Mehilli, N. von Beckerath, C. Bottiger, A. Schomig, and A. Kastrati Angiotensin I-converting enzyme (ACE) inhibitors and restenosis after coronary artery stenting in patients with the DD genotype of the ACE gene J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1957 - 1961. [Abstract] [Full Text] [PDF] |
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L. J. Feldman, P. Coste, A. Furber, P. Dupouy, M. S. Slama, J.-P. Monassier, C. Tron, A. Lafont, M. Faraggi, D. Le Guludec, et al. Incomplete Resolution of ST-Segment Elevation Is a Marker of Transient Microcirculatory Dysfunction After Stenting for Acute Myocardial Infarction Circulation, June 3, 2003; 107(21): 2684 - 2689. [Abstract] [Full Text] [PDF] |
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O. Gorchakova, W. Koch, N. von Beckerath, J. Mehilli, A. Schomig, and A. Kastrati Association of a genetic variant of endothelial nitric oxide synthase with the 1 year clinical outcome after coronary stent placement Eur. Heart J., May 1, 2003; 24(9): 820 - 827. [Abstract] [Full Text] [PDF] |
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S. D. Reed, P. W. Dillingham, A. H. Briggs, D. L. Veenstra, and S. D. Sullivan A Bayesian Approach to Aid in Formulary Decision Making: Incorporating Institution-Specific Cost-Effectiveness Data with Clinical Trial Results Med Decis Making, May 1, 2003; 23(3): 252 - 264. [Abstract] [PDF] |
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A.H. Gomma, M.A. Elrayess, C.J. Knight, E. Hawe, K.M. Fox, and S.E. Humphries The endothelial nitric oxide synthase (Glu298Asp and -786T>C) gene polymorphisms are associated with coronary in-stent restenosis Eur. Heart J., December 2, 2002; 23(24): 1955 - 1962. [Abstract] [PDF] |
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A. Schomig, J. Mehilli, H. Holle, K. Hosl, D. Kastrati, J.u. Pache, M. Seyfarth, F.-J. Neumann, J. Dirschinger, and A. Kastrati Statin treatment following coronary artery stenting and one-year survival J. Am. Coll. Cardiol., September 4, 2002; 40(5): 854 - 861. [Abstract] [Full Text] [PDF] |
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G. Schnyder, M. Roffi, Y. Flammer, R. Pin, and O. M. Hess Effect of Homocysteine-Lowering Therapy With Folic Acid, Vitamin B12, and Vitamin B6 on Clinical Outcome After Percutaneous Coronary Intervention: The Swiss Heart Study: A Randomized Controlled Trial JAMA, August 28, 2002; 288(8): 973 - 979. [Abstract] [Full Text] [PDF] |
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J. J. Popma, M. Suntharalingam, A. J. Lansky, R. R. Heuser, B. Speiser, P. S. Teirstein, V. Massullo, T. Bass, R. Henderson, S. Silber, et al. Randomized Trial of 90Sr/90Y {beta}-Radiation Versus Placebo Control for Treatment of In-Stent Restenosis Circulation, August 27, 2002; 106(9): 1090 - 1096. [Abstract] [Full Text] [PDF] |
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A. Diegeler, H. Thiele, V. Falk, R. Hambrecht, N. Spyrantis, P. Sick, K. W. Diederich, F. W. Mohr, and G. Schuler Comparison of Stenting with Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery N. Engl. J. Med., August 22, 2002; 347(8): 561 - 566. [Abstract] [Full Text] [PDF] |
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M. Singh, R. J. Lennon, D. R. Holmes Jr, M. R. Bell, and C. S. Rihal Correlates of procedural complicationsand a simple integer risk scorefor percutaneous coronary intervention J. Am. Coll. Cardiol., August 7, 2002; 40(3): 387 - 393. [Abstract] [Full Text] [PDF] |
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E. Van Belle, M. Perie, D. Braune, A. Chmait, T. Meurice, K. Abolmaali, E. P. McFadden, C. Bauters, J.-M. Lablanche, and M. E. Bertrand effects of coronary stenting on vessel patency and long-term clinical outcome after percutaneous coronary revascularization in diabetic patients J. Am. Coll. Cardiol., August 7, 2002; 40(3): 410 - 417. [Abstract] [Full Text] [PDF] |
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J Herrmann, C von Birgelen, M Haude, L Volbracht, N Malyar, H Eggebrecht, T F M Konorza, D Baumgart, and R Erbel Prognostic implication of cardiac troponin T increase following stent implantation Heart, June 1, 2002; 87(6): 549 - 553. [Abstract] [Full Text] [PDF] |
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T. Nishida, C. Di Mario, M.J. Kern, T.J. Anderson, I. Moussa, R. Bonan, T. Muramatsu, A.C. Jain, J. Suarez de Lezo, S.Y. Cho, et al. Impact of final coronary flow velocity reserve on late outcome following stent implantation Eur. Heart J., February 2, 2002; 23(4): 331 - 340. [Abstract] [Full Text] [PDF] |
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A. J. Lansky, G. Dangas, R. Mehran, K. J. Desai, G. S. Mintz, H. Wu, M. Fahy, G. W. Stone, R. Waksman, and M. B. Leon Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation J. Am. Coll. Cardiol., January 16, 2002; 39(2): 274 - 280. [Abstract] [Full Text] [PDF] |
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G. Schnyder, M. Roffi, R. Pin, Y. Flammer, H. Lange, F. R. Eberli, B. Meier, Z. G. Turi, and O. M. Hess Decreased Rate of Coronary Restenosis after Lowering of Plasma Homocysteine Levels N. Engl. J. Med., November 29, 2001; 345(22): 1593 - 1600. [Abstract] [Full Text] [PDF] |
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R. Moer, Y. Myreng, P. Molstad, P. Albertsson, P.a. Gunnes, B. Lindvall, R. Wiseth, K. Ytre-Arne, J. Kjekshus, and S. Golf Stenting in small coronary arteries (SISCA) trial: A randomized comparison between balloon angioplasty and the heparin-coated beStent J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1598 - 1603. [Abstract] [Full Text] [PDF] |
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A. Colombo, J. De Gregorio, I. Moussa, Y. Kobayashi, E. Karvouni, C. Di Mario, R. Albiero, L. Finci, and J. Moses Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1427 - 1433. [Abstract] [Full Text] [PDF] |
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E Vano, J Goicolea, C Galvan, L Gonzalez, L Meiggs, J I Ten, and C Macaya Skin radiation injuries in patients following repeated coronary angioplasty procedures Br. J. Radiol., November 1, 2001; 74(887): 1023 - 1031. [Abstract] [Full Text] [PDF] |
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S. Doucet, M. J. Schalij, M. C.M. Vrolix, D. Hilton, P. Chenu, B. de Bruyne, W. Udayachalerm, A. Seth, L. Bilodeau, J. H.C. Reiber, et al. Stent Placement to Prevent Restenosis After Angioplasty in Small Coronary Arteries Circulation, October 23, 2001; 104(17): 2029 - 2033. [Abstract] [Full Text] [PDF] |
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D. P. Chew, D. L. Bhatt, M. A. Robbins, M. S. Penn, J. P. Schneider, M. S. Lauer, E. J. Topol, and S. G. Ellis Incremental Prognostic Value of Elevated Baseline C-Reactive Protein Among Established Markers of Risk in Percutaneous Coronary Intervention Circulation, August 28, 2001; 104(9): 992 - 997. [Abstract] [Full Text] [PDF] |
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M. Moscucci, E. Kline-Rogers, D. Share, M. O'Donnell, A. Maxwell-Eward, W. L. Meengs, P. Kraft, A. C. DeFranco, J. L. Chambers, K. Patel, et al. Simple Bedside Additive Tool for Prediction of In-Hospital Mortality After Percutaneous Coronary Interventions Circulation, July 17, 2001; 104(3): 263 - 268. [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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J. Herrmann, M. Haude, A. Lerman, R. Schulz, L. Volbracht, J. Ge, A. Schmermund, H. Wieneke, C. von Birgelen, H. Eggebrecht, et al. Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation Circulation, May 15, 2001; 103(19): 2339 - 2345. [Abstract] [Full Text] [PDF] |
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D. Katritsis, S. Korovesis, E. Giazitzoglou, J. Parissis, P. Kalivas, M. M. Webb-Peploe, J. P.A. Ioannidis, and A. Haliassos C-Reactive Protein Concentrations and Angiographic Characteristics of Coronary Lesions Clin. Chem., May 1, 2001; 47(5): 882 - 886. [Abstract] [Full Text] [PDF] |
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W. Maier, O. Mini, J. Antoni, M. B. Wischnewsky, and B. Meier ABC Stenosis Morphology Classification and Outcome of Coronary Angioplasty : Reassessment With Computing Techniques Circulation, March 6, 2001; 103(9): 1225 - 1231. [Abstract] [Full Text] [PDF] |
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R. Y. L. Zee, A. Fernandez-Ortiz, C. Macaya, E. Pintor, K. Lindpaintner, and A. Fernandez-Cruz ACE D/I Polymorphism and Incidence of Post-PTCA Restenosis : A Prospective, Angiography-Based Evaluation Hypertension, March 1, 2001; 37(3): 851 - 855. [Abstract] [Full Text] [PDF] |
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