720-2 Predictors of Acute Complications After Percutaneous Coronary Revascularization with New Devices

Abstract

Studies of conventional balloon angioplasty (PTCA) have identified female gender, age, unstable angina, prior coronary bypass surgery, diabetes, lesion thrombus, and dissection as predictors of acute complications, but predictors of the risks of new device interventions are unknown. New devices were performed on 596 lesions in 561 patients including excimer laser angioplasty (n = 125), rotablator atherectomy (n = 111), and transluminal extraction atherectomy (n = 330) followed by adjunctive PTCA in 84% of lesions. Final procedural success was achieved in 86%. Serious angiographic complications (sidebranch occlusion, distal embolization, no reflow, abrupt closure, perforation) occurred in 9.4% of procedures after the new device and persisting in 3.2% after adjunctive PTCA. Major complications (non-Q-wave infarction, Q-wave infarction, emergency bypass surgery, death) occurred in 9.1% of patients. Multiple logistic regression was performed on all clinical and angiographic variables to identify independent predictors of serious angiographic and clinical complications: Predictors of Outcomes Wald statistic Odds Ratio (95% CI) Serious angiographic complication Prior PTCA of target lesion -291, P = 0004 0.44 (026-0.77) Interaction of thrombus &unstable angina 2.25, P = 002 3.96 (1.20-13.14) Interaction of thrombus &vein graft 2.35, P = 0.019 5.41 (133-22.04) Major clinical complication Serious angiographic complication 3.30, P = 0.0010 3.22 (1.61-6.47) Prior angioplastyof a target lesion (restenosis) is protective for angiographic complications with new devices. Intralesional thrombus in the setting of unstable angina or saphenous vein grafts confers an increased risk of angiographic complications. These angiographic complications, in turn, are predictive of major complications including nonfatal MI, emergency bypass surgery, and death.