Long-term outcome following successful reopening of abrupt closure after coronary angioplasty
Related Experiment Videos
A N Tenaglia1, D F Fortin, D J Frid
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Successfully reopening abrupt closure after coronary angioplasty increases long-term adverse events, particularly restenosis and myocardial infarction, in acute cases. Elective angioplasty patients also face higher risks of death and myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Abrupt closure is a complication of coronary angioplasty.
- Repeat dilation is a common treatment for abrupt closure.
- Long-term outcomes after successful reopening of abrupt closure require evaluation.
Purpose of the Study:
- To assess the long-term impact of successfully treated abrupt closure after coronary angioplasty.
- To compare adverse outcomes between patients with and without abrupt closure.
Main Methods:
- 1,056 patients undergoing acute or elective coronary angioplasty were followed.
- Abrupt closure occurred in 13.5% and was reopened in 58%.
- Outcomes including restenosis, death, myocardial infarction, and repeat procedures were compared.
Main Results:
- Restenosis rates were significantly higher in acute angioplasty patients with treated abrupt closure (64% vs 36%).
- Subsequent myocardial infarction and repeat angioplasty were more frequent in acute cases with abrupt closure.
- For elective angioplasty, death and myocardial infarction rates were higher in patients with abrupt closure.
Conclusions:
- Successfully treated abrupt closure is associated with increased long-term adverse events.
- The impact is more pronounced in patients undergoing acute coronary angioplasty.
- Careful monitoring and management are warranted for patients experiencing abrupt closure.
Abstract:
Abrupt closure after coronary angioplasty is often successfully treated by repeat dilation. Long-term follow-up, including 6-month repeat catheterization and 12-month clinical evaluation, was obtained in 1,056 patients treated with acute (n = 335) or elective (n = 721) coronary angioplasty to evaluate the long-term impact of successful reopening of abrupt closure. Abrupt closure occurred in 13.5% of patients and was successfully reopened in 58%. Adverse outcomes including restenosis, death, bypass surgery, myocardial infarction and repeat angioplasty were compared between patients with successfully treated abrupt closure and those with successful procedures (residual diameter stenosis < or = 50%) without abrupt closure. For patients with acute angioplasty, the restenosis rates (> 50% diameter stenosis at follow-up) were 64% for those with successfully treated abrupt closure versus 36% for those with successful procedures without abrupt closure (p < 0.01). In addition, subsequent myocardial infarction (12 vs 3%; p = 0.01) and repeat angioplasty (21 vs 10%; p = 0.03) were more frequent in the group with abrupt closure. For patients with elective angioplasty, restenosis was 43% in those with successfully treated abrupt closure versus 45% in those without abrupt closure (p = NS). Subsequent death and myocardial infarction were more frequent in patients with abrupt closure (death: 12 vs 3% [p < 0.01]; myocardial infarction: 13 vs 3% [p < 0.01]). Long-term adverse events are increased in patients with successfully treated abrupt closure compared to those with successful procedures without abrupt closure.