(Circulation. 1999;100:1971-1976.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Relation Between Lesion Characteristics and Risk With Percutaneous Intervention in the Stent and Glycoprotein IIb/IIIa Era
An Analysis of Results From 10 907 Lesions and Proposal for New Classification Scheme
From the Departments of Cardiology (S.G.E., V.G., P.L.W., E.J.T.) and Biostatistics (D.M.), The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Stephen G. Ellis, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, F-25, Cleveland, OH 44195. E-mail elliss{at}cesmtp.ccf.org
Background—The currently used
American College of Cardiology/American Heart
Association lesion classification scheme dates from an era when balloon
angioplasty was the only percutaneous treatment
available and major complications occurred in 
7% of patients. Major
advances in treatment options would suggest that this scheme may be
outmoded, but the schemes that have been suggested to update lesion
classification have not been widely accepted.
Methods and Results—Four thousand one hundred eighty-one
consecutive patients (6676 lesions) formed a training set and 2146
patients (4231 lesions) formed a validation set treated from 1995 to
1997 at a single center used by 3 hospital groups. Twenty-seven
pretreatment candidate variables were analyzed with the use
of stepwise proportional logistic regression, and 9 (nonchronic total
occlusion with TIMI flow 0, degenerated vein graft, vein graft age >10
years, lesion length 
10 mm, severe calcium, lesion irregularity,
large filling defect, angulated 45 degrees plus calcium, and
eccentricity) were independently correlated (P<0.05)
with ranked adverse outcome (death, Q-wave or creatine kinase 3x
normal myocardial infarction, or emergency coronary artery
bypass grafting>>creatine kinase 2 to 3x myocardial
infarction>>possibly related to non–Q-wave myocardial infarction>>no
complication). A scheme based on these findings and the old American
College of Cardiology/American Heart Association scheme
were found to have c-statistics in the validation set of 0.672 and
0.620 (P=0.010 vs old scheme), respectively.
Conclusions—Appreciation of these contemporary risk factors for complications of coronary intervention may assist in patient selection and in risk adjustment for comparison of outcomes between providers.
Key Words: angioplasty • stents • platelet aggregation inhibitors • risk factors • angiography
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