BACKGROUND: Complications from coronary angioplasty remain a concern despite improvements in technology and operator's skills. Identification of high-risk patients is important with regard to surgical standby and other precautions that have to be taken for such patients. METHODS: Prior to elective coronary angioplasty, the probability of success and the risk of complications were estimated on the basis of angiographic and clinical characteristics. A total of 2365 consecutive elective procedures were evaluated. Estimates for success and complications were classified into three categories: high, intermediate or low probability. RESULTS: Angioplasty success was achieved in 1025 of 1056 (97%) procedures with high success probability; in 833 of 914 (91%) with intermediate success probability and 304 of 395 (77%) with low success probability. Complications occurred in five of 271 (2%) procedures with an anticipated low risk of complications, in 72 of 1973 (4%) procedures with a intermediate risk and in 13 of 121 (11%) procedures with a high risk of complications. Out of a total of 28, 22 (80%) surgical bypass procedures were performed in the intermediate anticipated risk category. CONCLUSIONS: For groups of patients, reliable prediction of success and complications is possible. However, most emergency bypass surgery after failed angioplasty is performed in patients with a predicted intermediate risk of complications. Interventional cardiologists are not able to identify in advance the majority of patients who will need surgery for failed angioplasty.
BACKGROUND: Complications from coronary angioplasty remain a concern despite improvements in technology and operator's skills. Identification of high-risk patients is important with regard to surgical standby and other precautions that have to be taken for such patients. METHODS: Prior to elective coronary angioplasty, the probability of success and the risk of complications were estimated on the basis of angiographic and clinical characteristics. A total of 2365 consecutive elective procedures were evaluated. Estimates for success and complications were classified into three categories: high, intermediate or low probability. RESULTS: Angioplasty success was achieved in 1025 of 1056 (97%) procedures with high success probability; in 833 of 914 (91%) with intermediate success probability and 304 of 395 (77%) with low success probability. Complications occurred in five of 271 (2%) procedures with an anticipated low risk of complications, in 72 of 1973 (4%) procedures with a intermediate risk and in 13 of 121 (11%) procedures with a high risk of complications. Out of a total of 28, 22 (80%) surgical bypass procedures were performed in the intermediate anticipated risk category. CONCLUSIONS: For groups of patients, reliable prediction of success and complications is possible. However, most emergency bypass surgery after failed angioplasty is performed in patients with a predicted intermediate risk of complications. Interventional cardiologists are not able to identify in advance the majority of patients who will need surgery for failed angioplasty.
Authors: R K Myler; R E Shaw; S H Stertzer; H S Hecht; C Ryan; J Rosenblum; D C Cumberland; M C Murphy; H N Hansell; B Hidalgo Journal: J Am Coll Cardiol Date: 1992-06 Impact factor: 24.094
Authors: J H Chesebro; G Knatterud; R Roberts; J Borer; L S Cohen; J Dalen; H T Dodge; C K Francis; D Hillis; P Ludbrook Journal: Circulation Date: 1987-07 Impact factor: 29.690
Authors: H L Lazar; D P Faxon; G Paone; A Rajaii-Khorasani; A K Jacobs; M P Fallon; R J Shemin Journal: Ann Thorac Surg Date: 1992-02 Impact factor: 4.330
Authors: D R Holmes; R Holubkov; R E Vlietstra; S F Kelsey; G S Reeder; G Dorros; D O Williams; M J Cowley; D P Faxon; K M Kent Journal: J Am Coll Cardiol Date: 1988-11 Impact factor: 24.094