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Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile
A M Lincoff1, J J Popma, S G Ellis
1University of Michigan, Ann Arbor.
Insights
Abrupt vessel closure during coronary angioplasty is a significant risk, but prolonged balloon inflations and intracoronary stents show promise for improving outcomes. Further research is needed for better prevention and treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Abrupt vessel closure is a serious complication during percutaneous coronary intervention (PCI).
- Understanding the factors influencing outcomes is crucial for patient management.
- This study investigates clinical, angiographic, and procedural correlates of outcome following abrupt vessel closure.
Purpose of the Study:
- To identify predictors of successful outcome after abrupt vessel closure during coronary angioplasty.
- To evaluate the impact of prolonged balloon inflations and intracoronary stenting on patient outcomes.
- To assess the overall morbidity and mortality associated with abrupt vessel closure.
Main Methods:
- Analysis of 109 patients experiencing abrupt vessel closure during 1,319 coronary angioplasty procedures.
- Evaluation of clinical, angiographic (thrombus, dissection), and procedural variables.
- Hierarchical and multivariate analyses to determine independent correlates of successful outcome.
Main Results:
- Successful reversal of abrupt vessel closure was achieved in 43% of patients.
- Prolonged balloon inflations (>120s) and intracoronary stenting were independently associated with successful outcomes (OR=5.11, p=0.001 and OR=4.37, p=0.049, respectively).
- Overall incidence of death, emergency bypass surgery, and myocardial infarction was significant.
Conclusions:
- Prolonged balloon inflations and intracoronary stenting may improve outcomes in abrupt vessel closure.
- Despite these interventions, significant risks of morbidity and mortality persist.
- Improved strategies for prevention and treatment of abrupt vessel closure are warranted.
Abstract:
To assess the clinical, angiographic and procedural correlates of outcome after abrupt vessel closure during coronary angioplasty, results were analyzed of 109 patients (8.3%) who had abrupt vessel closure during 1,319 consecutive coronary angioplasty procedures performed between July 1, 1988 and June 30, 1990. These 109 patients had a mean age of 59 +/- 11 years; 63% were male, 57% had had a prior myocardial infarction and 61% had multivessel disease. Coronary angioplasty was performed in the settings of acute myocardial infarction (14%), recent myocardial infarction (36%), unstable angina (34%) and stable ischemia (29%). Abrupt vessel closure occurred at a median of 27 min (range 0 min to 5 days) from the first balloon inflation. By angiographic criteria, thrombus or coronary dissection was identified in 20% and 28% of cases, respectively; both thrombus and dissection were present in 7% of closures, and 45% were due to indeterminate mechanisms. Successful reversal of abrupt vessel closure, defined as restoration of normal Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow without resultant Q wave myocardial infarction, emergency bypass surgery or death, was achieved in 47 patients (43%). By hierarchal analysis, the incidence of death, emergency coronary bypass surgery, Q wave and non-Q wave myocardial infarction was 8%, 20%, 9% and 11%, respectively. Univariate analysis using 23 clinical, morphologic and procedural variables demonstrated that successful outcome after abrupt closure was associated with prolonged balloon inflations (greater than 120 s) (odds ratio = 6.87, p less than 0.001), unstable angina (odds ratio = 2.37, p = 0.034) and placement of an intracoronary stent (odds ratio = 5.33, p = 0.062). By multivariate analysis, independent correlates of successful outcome were prolonged balloon inflations (odds ratio = 5.11, p = 0.001) and intracoronary stenting (odds ratio = 4.37, p = 0.049). Thus, although prolonged balloon inflations and intracoronary stents may improve outcome after abrupt vessel closure, the cumulative risk of morbidity or mortality remains significant and mandates investigation into improved strategies for its prevention and treatment.