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In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty
Insights
This study on coronary angioplasty found a 4.1% major complication rate. Key predictors included multivessel disease and intimal dissection, highlighting procedural factors in patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Complications
Background:
- Elective percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Understanding in-hospital complications is crucial for improving patient safety and procedural outcomes.
Purpose of the Study:
- To prospectively record and analyze in-hospital complications following elective PTCA.
- To identify predictors of major complications during PTCA procedures.
Main Methods:
- Prospective recording of complications in 3500 patients undergoing elective PTCA from 1980-1984.
- Analysis of 3933 attempted lesions, including multiple-lesion and saphenous vein graft PTCA.
- Univariate and multivariate analysis to identify pre-procedure and procedural predictors of major complications.
Main Results:
- A primary success rate of 91% was achieved for PTCA.
- Major complications occurred in 4.1% of patients, including emergency coronary artery bypass graft surgery (2.7%), myocardial infarction (2.6%), and a total mortality rate of 0.1%.
- Pre-procedure predictors of major complications included multivessel coronary disease, lesion eccentricity, calcification, female gender, and lesion length. Intimal dissection was the strongest procedural predictor.
Conclusions:
- Elective PTCA has a low overall complication rate, but specific patient and lesion characteristics increase risk.
- Intimal dissection is a critical procedural event associated with major complications.
- Identifying predictors allows for risk stratification and potential procedural adjustments to enhance patient safety.
Abstract:
We prospectively recorded all in-hospital complications of the first 3500 consecutive patients to undergo elective coronary angioplasty (PTCA) at Emory University Hospitals from July 14, 1980, to August 28, 1984, by three operators. PTCA was attempted in a total of 3933 lesions, with a primary success rate of 91%. Multiple-lesion PTCA was performed in 401 patients, and PTCA of saphenous vein grafts was attempted in 172. No complications were recorded in 3116 (89%) cases, isolated minor complications occurred in 241 (6.9%), and major complications (emergency surgery, myocardial infarction, death) were observed in 145 (4.1%). Emergency coronary artery bypass graft surgery (CABG) was performed in 96 patients (2.7%), with a myocardial infarction rate of 49% (47/96), a Q wave infarction rate of 23% (22/96), and an emergency surgery mortality rate of 2% (2/96). Hospital discharge occurred within 2 weeks of attempted PTCA in 91% (87/96) of patients undergoing emergency CABG. The overall myocardial infarction rate was 2.6% (94/3500). There were two nonsurgical deaths, giving a total mortality rate of 0.1% (4/3500). Univariate and multivariate analysis of 3099 patients undergoing single-lesion PTCA identified five preprocedure predictors of a major complication: multivessel coronary disease, lesion eccentricity, presence of calcium in the lesion, female gender, and lesion length. Unstable angina, duration of angina, lesion severity, previous CABG, and vein graft dilatation were not associated with an increased incidence of major complications. The strongest predictor of a major complication was the procedural appearance of an intimal dissection. Intimal dissection was evident in 894/3099 (29%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)