Immediate outcome following coronary angioplasty. A contemporary single centre audit.

Abstract

To study the in-hospital outcome of all coronary angioplasty procedures performed in a single centre over a 1 year period, with regard to angiographic success and the clinical complications of death, myocardial infarction, emergency coronary bypass surgery and abrupt coronary occlusion necessitating reintervention. One thousand one hundred and thirty-three lesions were treated in 970 procedures in 799 patients between October 1993 and October 1994. Clinical, procedural, angiographic and outcome data were entered into a dedicated computer data-base and variables tested with respect to outcome using the chi-square test and univariate and multivariate analysis techniques. Angioplasty was performed for stable angina in 473 (49%) patients, unstable angina in 410 (42%) and 80 procedures were emergency--primary myocardial infarction in 44 (4.5%), shock in two, abrupt closure in 34 (3.5%) and other indications in seven patients. There were 10 (1.0%) deaths and 71 (7.3%) patient were documented to have suffered a myocardial infarction as a result of angioplasty. Nineteen (2.0%) patients underwent emergency coronary artery bypass surgery. Age >60 and a type C lesion were found to be associated with angiographic failure. The chance of a complication was increased if the patient was aged >60 years, suffered unstable angina, had an ejection fraction <50%, was treated with a new device or suffered a significant dissection. Despite refinement in techniques and increased experience, coronary angioplasty retains a significant associated chance of angiographic failure. The complication rate remains significant and there has been little reduction in mortality, infarction and abrupt closure rates over the last 15 years. The requirement for emergency coronary artery bypass surgery appears to be diminishing with the introduction of improved bail-out techniques, in particular intracoronary stenting.