Description of patients undergoing high risk angioplasty. Analyses of various databases

As the pharmacological and mechanical management of angioplasty procedures advances, the description of risk incurred during and after the procedure becomes increasingly important. A variety of measures from different sorts of databases have been devised to facilitate this task. Large public databases generally include descriptors of overall physical health and are most useful in predicting catastrophic outcomes, such as mortality. Data from smaller angiographic databases are more useful in providing specific descriptors of more common but less catastrophic events, such as abrupt closure, myocardial infarction, and emergency coronary artery bypass. Most complications are associated with abrupt closure of the vessel dilated. In modern PTCA series, the risk of serious ishcaemic complications ranges from as low as 3% to as high as 12.9%. Since the inception of angioplasty, it has been observed repeatedly that angiographic characteristics of target lesions can predict the likelihood of both success and ischaemic complications. It has also become apparent that such clinical factors as unstable angina with ST segment changes or recent myocardial infarction also play important roles by providing a thrombogenic milieu in which the risk of intravascular thrombosis is increased. Although advances in operator skills and equipment, as well as new devices have dramatically increased the degree of lesion complexity which may be approached with PTCA, the actual characteristics which are associated with abrupt closure have undergone little change.