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Does the AHA/ACC task force grading system predict outcome in multivessel coronary angioplasty?
B Moushmoush1, B Kramer, A M Hsieh
1Department of Medicine, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, Illinois.
Insights
The ACC/AHA grading system predicts percutaneous transluminal coronary angioplasty outcomes. Complex lesions (Type C) had lower success rates and higher complications, indicating the system
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Multivessel percutaneous transluminal coronary angioplasty (PTCA) involves complex procedures.
- The American College of Cardiology/American Heart Association (ACC/AHA) task force grading system stratifies coronary lesion complexity.
- Predicting PTCA outcomes is crucial for patient management and procedural planning.
Purpose of the Study:
- To evaluate the ACC/AHA task force grading system's effectiveness in predicting PTCA outcomes.
- To analyze failure rates in patients undergoing multivessel PTCA based on lesion characteristics.
- To identify key predictors of failed angioplasty procedures.
Main Methods:
- Retrospective analysis of 97 patients with 328 stenoses undergoing multivessel PTCA.
- Classification of lesions according to AHA/ACC types (A, B, C) and analysis of procedural success and complications.
- Logistic regression analysis to identify predictors of angioplasty failure.
Main Results:
- Procedural success was 81.1%, with an 8.2% major complication rate and 2% in-hospital mortality.
- Success rates varied significantly by lesion type: 84% for Type A, 89% for Type B, and 64% for Type C (p < 0.0001).
- Total occlusion (both >3 and <3 months) and severely angulated segments were the strongest predictors of failed angioplasty.
Conclusions:
- The ACC/AHA grading system is a valuable predictor of PTCA outcomes, with higher complexity lesions demonstrating poorer results.
- Lesion characteristics, particularly total occlusion and severe angulation, are critical factors influencing angioplasty success.
- Risk stratification using the ACC/AHA system can aid in optimizing patient selection and procedural strategies for multivessel PTCA.
Abstract:
To assess the ACC/AHA task force grading system as a predictor of outcome in patients undergoing multivessel percutaneous transluminal coronary angioplasty we analyzed all failures (residual stenosis > 50%, Q-wave myocardial infarction, coronary artery bypass grafting during hospitalization, or death) in 97 patients with 328 stenoses. There were 70 males and 27 females; 60 patients had stable angina, and 37 had unstable angina. The mean number of lesions dilated per patient was 3.4 (range 2-8). The mean preangioplasty percent luminal diameter narrowing was 80 +/- 14%. Thirty-eight stenoses were AHA/ACC classification type A, 192 type B, and 98 type C. One hundred twenty-eight lesions were located in the left anterior descending artery or its distribution, 89 in the left circumflex, 96 in the right coronary artery, and 15 in other vessels. Procedural success (< 50% residual diameter narrowing and no major ischemic complications) was achieved in 266 lesions (81.1%). Major ischemic complications (death, myocardial infarction, or emergency bypass surgery) occurred in 8 patients (8.2%) and in-hospital mortality was 2%. Analysis on a per stenosis basis demonstrated 84% success in type A, 89% in type B, and 64% in type C (p < 0.0001). When type B was divided into type B1 (1 type B characteristic) and type B2 (two or more type B characteristics) the success rate was 90% vs. 88% and the complication rate was 1% vs. 2%, respectively (p = n.s.). Logistic regression analysis showed that the best single predictor of failed angioplasty was total occlusion > 3 months, followed by total occlusion < 3 months and severely angulated (> 90 degrees) segment.(ABSTRACT TRUNCATED AT 250 WORDS)