Prediction of success and major complications during elective coronary angioplasty

Abstract

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.

Keywords: coronary angioplasty; coronary bypass surgery; coronary heart disease.