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[Acute occlusion after coronary angioplasty. Early management and late course]
G L Nunes1, A G Sousa, L F Tanajura
1Instituto Dante Pazzanese de Cardiologia, São Paulo.
Insights
Acute coronary occlusion after angioplasty is serious, leading to high rates of myocardial infarction and death. Repeat vessel redilation offers better outcomes than medical management for these patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Complications
Background:
- Acute coronary occlusion is a severe complication following percutaneous transluminal coronary angioplasty (PTCA).
- This complication is associated with significant morbidity and mortality.
- Effective management strategies are crucial for improving patient prognosis.
Purpose of the Study:
- To evaluate the effectiveness of various management strategies for acute coronary occlusion post-PTCA.
- To determine the long-term prognosis for patients experiencing this complication.
- To identify predictors of poor in-hospital outcomes.
Main Methods:
- Analysis of 100 patients who experienced acute vessel closure after PTCA between 1987 and 1990.
- Assessment of treatment strategies: emergency bypass surgery, clinical management, and redilation.
- Evaluation of in-hospital outcomes and late follow-up (mean 17 months) in survivors.
Main Results:
- The incidence of acute myocardial infarction was 57%, and death occurred in 12% of patients.
- Clinical management resulted in a higher myocardial infarction rate (74.3%) compared to redilation (50%) or surgery (48.8%).
- Repeat redilation was associated with a lower death rate (4.2%) and better long-term symptom status compared to medical therapy.
Conclusions:
- Acute coronary occlusion is a critical PTCA complication with high mortality.
- Low left ventricular ejection fraction and left anterior descending artery involvement predict worse in-hospital outcomes.
- Late prognosis is unfavorable for patients treated medically during the acute phase.
Purpose:
Assess the efficacy of the different strategies employed in the management of acute closure and verify the late prognosis of patients who develop this complication.
Methods:
From january 1987, through December 1990, 2315 consecutive patients underwent percutaneous transluminal coronary angioplasty (PTCA) in our Institution. We analyzed 100 patients who had had acute closure of the dilated vessel determining the total incidence of myocardial infarction and death, the effectiveness of the different treatment strategies and clinical and angiographic predictors of poor in-hospital outcome. Late follow-up was obtained in the hospital survivors.
Results:
The incidence of acute myocardial infarction in the group of 100 patients was 57%; death occurred in 12% of the patients. Forty-one individuals were referred to emergency bypass surgery, 35 received clinical treatment and 24 underwent redilatation of the vessel. Those managed clinically had a higher incidence of myocardial infarction compared to the ones who underwent either redilatation or surgery (74.3% versus 50% and 48.8%). The in-hospital mortality rate was significantly higher in patients with left ventricular ejection fraction < 45% (44.4%, p < 0.001) and in procedures involving the left anterior descending artery (20%, p < 0.05); patients undergoing repeat dilatation had the lower death rate (4.2% versus 8.6% in the clinical group and 17.1% in the surgical group). Late follow-up was obtained in 65 of 88 hospital survivors (mean follow-up = 17 months). Patients who underwent repeat dilatation were significantly less symptomatic in the follow-up than those who received medical therapy during the acute phase (89% versus 60.9% of patients without symptoms respectively, p < 0.05). Patients who were referred to surgery had also a tendency towards having less symptoms (87.5% of asymptomatic patients in the late follow-up) although the difference was not statistically significant (0.01 > p > 0.05).
Conclusion:
Acute coronary occlusion is a serious complication of angioplasty and is associated with high rates of major complications (myocardial infarction, death). Low left ventricular ejection fraction and PTCA involving the left anterior descending are predictors of higher in-hospital mortality in patients with acute closure. Late outcome is less favourable in patients submitted to clinical treatment in the acute phase.