Acute Occlusion During Coronary Interventions: The Changing Pattern in the Era of Stents

Acute procedural Occlusion continues to be a major cause of morbidity and mortality associated with coronary interventions. The incidence, management, and clinical outcomes of procedural occlusion of 2,138 patients undergoing coronary intervention were analyzed. The acute occlusion rate increased from 5.2% in 1994 to 8.0% in 1995 (p = 0.001). The success rate for managing such acute procedural occlusion improved significantly from 93% in 1994 to 100% in 1995 (p = 0.003). The composite endpoints of coronary artery bypass surgery, non-fatal myocardial infarction or death decreased from 16.4% in 1994 to 11.4% in 1995 (p = ns). The increased acute procedural occlusion rate in 1995 likely represents a more aggressive approach on more complex lesion types as well as higher total numbers of evolving myocardial infarctions, while the improvement in successful management of acute occlusion probably represents increased utilization of stents, improved and modified procedural technique and better antiplatelet/anticoagulation therapy.