In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8,207 procedures

Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia 30322.

Cardiac death consequent to acute vessel closure after coronary angioplasty occurred in 13 of 294 closures from 8,207 consecutive procedures performed at two centers since 1981 (0.16% cardiac mortality rate). To determine the predictors of cardiac death after acute coronary closure, 50 clinical, angiographic and procedural variables were analyzed by an observer unaware of the clinical outcome for each of the 13 patients who died and also 100 patients randomly chosen, in whom vessel closure after angioplasty did not result in death during hospitalization. Univariate analysis found female gender (p less than 0.0001), collateral channels from the vessel dilated (p less than 0.0001), use of balloon counterpulsation (p less than 0.0002), pre- and postprocedural hypotension (p = 0.0003 and p = 0.003, respectively), jeopardy score greater than or equal to 2.5 (p = 0.003), left ventricular hypertrophy (p = 0.013), hypertension (p = 0.02), diabetes (p = 0.02) and multivessel disease (p = 0.03) to be predictive of death. Multivariate analysis found collateral vessels, female gender and multivessel disease to be independent predictors of death. Thus, cardiac death after elective coronary angioplasty is very rare in experienced centers and occurs most often in women with a large amount of potentially ischemic myocardium. Hypotension often precedes the fatal closure event. Close attention to the amount of potentially ischemic myocardium and to the fluid volume status of these patients would seem to be especially warranted.

This article has been cited by other articles:

				J. M. Wilson and J. T. Willerson Myocardial Revascularization with Percutaneous Devices Card. Surg. Adult, January 1, 2008; 3(2008): 573 - 598. [Full Text]

				L. S. Fernandes, J. E. Tcheng, J. C. O'Shea, B. Weiner, T. J. Lorenz, C. Pacchiana, L. G. Berdan, K. J. Maresh, D. Joseph, M. Madan, et al. Is glycoprotein IIb/IIIa antagonism as effective in women as in men following percutaneous coronary intervention?: Lessons from the ESPRIT study J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1085 - 1091. [Abstract] [Full Text] [PDF]

				A. M Dart, X.-J. Du, and B. A Kingwell Gender, sex hormones and autonomic nervous control of the cardiovascular system Cardiovasc Res, February 15, 2002; 53(3): 678 - 687. [Full Text] [PDF]

				T Pohl, P Hochstrasser, M Billinger, M Fleisch, B Meier, and C Seiler Influence on collateral flow of recanalising chronic total coronary occlusions: a case-control study Heart, October 1, 2001; 86(4): 438 - 443. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				S. B. King III Acute myocardial infarction: are diabetics different? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1513 - 1515. [Full Text] [PDF]

				R. J. Morris, M.L.R. Kuretu, K. E. Grunewald, L. E. Samuels, M. D. Strong, A. S. Wechsler, and R. J. Morris Surgical Treatment of Interventional Coronary Angiographic Accidents Angiology, October 1, 1999; 50(10): 789 - 795. [Abstract] [PDF]

				M. Rabah, D. Mason, D. W. M. Muller, R. Hundley, A. D. Kugelmass, B. Weiner, L. Cannon, W. W. O'Neill, and R. D. Safian Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention J. Am. Coll. Cardiol., August 1, 1999; 34(2): 461 - 467. [Abstract] [Full Text] [PDF]

				Th. Budde, M. Haude, H.W. Hopp, S. Kerber, G. Caspari, G. Fassbender, M. Fingerhut, I. Novopashenny, Y. Ogurol, G. Breithardt, et al. A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project Eur. Heart J., March 1, 1999; 20(5): 354 - 363. [Abstract] [PDF]

				H. L. Lazar, A. K. Jacobs, G. S. Aldea, O. M. Shapira, D. Lancaster, and R. J. Shemin Factors Influencing Mortality After Emergency Coronary Artery Bypass Grafting for Failed Percutaneous Transluminal Coronary Angioplasty Ann. Thorac. Surg., December 1, 1997; 64(6): 1747 - 1752. [Abstract] [Full Text]

				C. J. White, S. R. Ramee, T. J. Collins, A. E. Escobar, A. Karsan, D. Shaw, S. P. Jain, T. A. Bass, R. R. Heuser, P. S. Teirstein, et al. Coronary Thrombi Increase PTCA Risk : Angioscopy as a Clinical Tool Circulation, January 15, 1996; 93(2): 253 - 258. [Abstract] [Full Text]

				J. A. Bittl, J. Strony, J. A. Brinker, W. H. Ahmed, C. R. Meckel, B. R. Chaitman, J. Maraganore, E. Deutsch, B. Adelman, and The Hirulog Angioplasty Study Investigators Treatment with Bivalirudin (Hirulog) as Compared with Heparin during Coronary Angioplasty for Unstable or Postinfarction Angina N. Engl. J. Med., September 21, 1995; 333(12): 764 - 769. [Abstract] [Full Text] [PDF]

				M. W. Wolfe, G. S. Roubin, M. Schweiger, J. M. Isner, J. J. Ferguson, A. D. Cannon, M. Cleman, H. Cabin, F. Leya, R. Bonan, et al. Length of Hospital Stay and Complications After Percutaneous Transluminal Coronary Angioplasty : Clinical and Procedural Predictors Circulation, August 1, 1995; 92(3): 311 - 319. [Abstract] [Full Text]

				N. Wang, S. R. Gundry, G. Van Arsdell, A. J. Razzouk, A. C. Hill, M. Sjolander, K. A. Cavazos, J. M. Brewer, E. E. Vyhmeister, and L. L. Bailey Percurtaneous transluminal coronary angioplasty failures in patients with multivessel diseaseIs there an increased risk? J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 214 - 223. [Abstract] [Full Text]

				J. J. Mason, D. K. Owens, R. A. Harris, J. P. Cooke, and M. A. Hlatky The Role of Coronary Angiography and Coronary Revascularization Before Noncardiac Vascular Surgery JAMA, June 28, 1995; 273(24): 1919 - 1925. [Abstract] [PDF]

				M. R. Bell, D. E. Grill, K. N. Garratt, P. B. Berger, B. J. Gersh, and D. R. Holmes Jr Long-term Outcome of Women Compared With Men After Successful Coronary Angioplasty Circulation, June 15, 1995; 91(12): 2876 - 2881. [Abstract] [Full Text]

				F. E. Kuhn and C. E. Rackley Coronary Artery Disease in Women: Risk Factors, Evaluation, Treatment, and Prevention Arch Intern Med, December 13, 1993; 153(23): 2626 - 2636. [Abstract] [PDF]

				M. R. Bell, D. R. Holmes Jr, P. B. Berger, K. N. Garratt, K. R. Bailey, and B. J. Gersh The Changing In-Hospital Mortality of Women Undergoing Percutaneous Transluminal Coronary Angioplasty JAMA, April 28, 1993; 269(16): 2091 - 2095. [Abstract] [PDF]

				E. L. Hannan, D. T. Arani, L. W. Johnson, H. G. Kemp Jr, and G. Lukacik Percutaneous Transluminal Coronary Angioplasty in New York State: Risk Factors and Outcomes JAMA, December 2, 1992; 268(21): 3092 - 3097. [Abstract] [PDF]

				E. L. Hannan, H. Kilburn Jr, J. F. O'Donnell, G. Lukacik, and E. P. Shields Adult Open Heart Surgery in New York State: An Analysis of Risk Factors and Hospital Mortality Rates JAMA, December 5, 1990; 264(21): 2768 - 2774. [Abstract] [PDF]

				J. B. Wong, F. A. Sonnenberg, D. N. Salem, and S. G. Pauker Myocardial Revascularization for Chronic Stable Angina: Analysis of the Role of Percutaneous Transluminal Coronary Angioplasty Based on Data Available in 1989 Ann Intern Med, December 1, 1990; 113(11): 852 - 871. [Abstract] [PDF]

				PRACTICE MAKES (ALMOST) PERFECT IN ANGIOPLASTY Journal Watch (General), February 16, 1988; 1988(216): 5 - 5. [Full Text]