Coronary heart disease: multivessel disease, unstable angina and a complex lesion increased the risk of occlusion.

Clinical bottom line (level 3b)

  1. Less than a tenth of patients who undergo percutaneous transluminal coronary angioplasty had an acute coronary artery occlusion during or after the procedure.
  2. Patients undergoing coronary angioplasty were at an increased risk of acute coronary artery occlusion if they had: multivessel disease, unstable angina or a complex lesion.
de Feyter et al: Circulation 1991; 83 (3): 927-936
Expires March 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: thorax centre, The Netherlands

208 patients (aged range 31 to 78 years; mean 57, 74% male) coronary artery occlusion during percutaneous transluminal coronary angioplasty

Excluded if
  • surgery due to MI
  • procedure performed in saphenous vein bypass grafts


    • Cases: 104 patients (76% male, mean age 56): with coronary artery occlusion, during or after angioplasty
    Controls: 104 patients (71% male, mean age 57): without coronary artery occlusion

    Factors studied:
  • acute coronary artery occlusion


    • Factors summarised:
  • multivessel disease
  • unstable angina
  • complex lesion


    • Multivariate analyses were used to adjust for confounding factors.

    Outcomes studied:
  • acute coronary artery occlusion

    • The 104 patients without occlusion were randomly selected by date of angioplasty for comparison with those with occlusion.

    The evidence

    Patient expected event rate for acute coronary artery occlusion: 7.30%
    risk factor acute coronary artery occlusion
    present    		 acute coronary artery occlusion
    absent    		 unadjusted OR
    (% CI)    		 NNH
    (95% CI)
    multivessel disease 56 48 4
    ( to )
    no multivessel disease 48 1271

    risk factor acute coronary artery occlusion
    present    		 acute coronary artery occlusion
    absent    		 unadjusted OR
    (% CI)    		 NNH
    (95% CI)
    unstable angina 66 38 2
    ( to )
    no unstable angina 38 1281

    risk factor acute coronary artery occlusion
    present    		 acute coronary artery occlusion
    absent    		 unadjusted OR
    (% CI)    		 NNH
    (95% CI)
    complex lesion 57 47 2
    ( to )
    no complex lesion 47 1272

    Comments

    1. The clinical value of conclusions related to the frequency, management and outcome of acute coronary artery occlusion should be interpreted under an important limitation; the field of coronary angioplasty has been rapidly changing during the last decade.
    2. The widely accepted role of IIb/IIIa inhibitors and even the recent modifications of guidelines for elective PTCA will alter the interpretation of this data.

    Citation

    1. de Feyter PJ, van den Brand M, Jaarman G, et al: Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty: Frequency, prediction, clinical course, management, and follow-up. Circulation 1991; 83 (3): 927-936
    Contributor: Clare Wotton and Musab Hayatli, January 2000
    Reviewer: Andreas Michaelides

    Clinical Question.
    Patient percutaneous transluminal coronary angioplasty
    Intervention or Exposure presence of prognostic factors
    Comparison absence of factors
    Outcome acute coronary artery occlusion