Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile

University of Michigan, Ann Arbor.

To assess the clinical, angiographic and procedural correlates of outcome after abrupt vessel closure during coronary angioplasty, results were analyzed of 109 patients (8.3%) who had abrupt vessel closure during 1,319 consecutive coronary angioplasty procedures performed between July 1, 1988 and June 30, 1990. These 109 patients had a mean age of 59 +/- 11 years; 63% were male, 57% had had a prior myocardial infarction and 61% had multivessel disease. Coronary angioplasty was performed in the settings of acute myocardial infarction (14%), recent myocardial infarction (36%), unstable angina (34%) and stable ischemia (29%). Abrupt vessel closure occurred at a median of 27 min (range 0 min to 5 days) from the first balloon inflation. By angiographic criteria, thrombus or coronary dissection was identified in 20% and 28% of cases, respectively; both thrombus and dissection were present in 7% of closures, and 45% were due to indeterminate mechanisms. Successful reversal of abrupt vessel closure, defined as restoration of normal Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow without resultant Q wave myocardial infarction, emergency bypass surgery or death, was achieved in 47 patients (43%). By hierarchal analysis, the incidence of death, emergency coronary bypass surgery, Q wave and non-Q wave myocardial infarction was 8%, 20%, 9% and 11%, respectively. Univariate analysis using 23 clinical, morphologic and procedural variables demonstrated that successful outcome after abrupt closure was associated with prolonged balloon inflations (greater than 120 s) (odds ratio = 6.87, p less than 0.001), unstable angina (odds ratio = 2.37, p = 0.034) and placement of an intracoronary stent (odds ratio = 5.33, p = 0.062). By multivariate analysis, independent correlates of successful outcome were prolonged balloon inflations (odds ratio = 5.11, p = 0.001) and intracoronary stenting (odds ratio = 4.37, p = 0.049). Thus, although prolonged balloon inflations and intracoronary stents may improve outcome after abrupt vessel closure, the cumulative risk of morbidity or mortality remains significant and mandates investigation into improved strategies for its prevention and treatment.

This article has been cited by other articles:

				L. T. Newsome, M. A. Kutcher, and R. L. Royster Coronary Artery Stents: Part I. Evolution of Percutaneous Coronary Intervention Anesth. Analg., August 1, 2008; 107(2): 552 - 569. [Abstract] [Full Text] [PDF]

				D. J. Kereiakes and P. A. Gurbel Peri-Procedural Platelet Function and Platelet Inhibition in Percutaneous Coronary Intervention J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 111 - 121. [Abstract] [Full Text] [PDF]

				O. F. Bertrand, R. De Larochelliere, J. Rodes-Cabau, G. Proulx, O. Gleeton, C. Manh Nguyen, J.-P. Dery, G. Barbeau, B. Noel, E. Larose, et al. A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation Circulation, December 12, 2006; 114(24): 2636 - 2643. [Abstract] [Full Text] [PDF]

				E J Smith, A Mathur, and M T Rothman Recent advances in primary percutaneous intervention for acute myocardial infarction Heart, December 1, 2005; 91(12): 1533 - 1536. [Full Text] [PDF]

				D. J. Kereiakes, R. E. Kuntz, L. Mauri, and M. W. Krucoff Surrogates, substudies, and real clinical end points in trials of drug-eluting stents J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1206 - 1212. [Full Text] [PDF]

				J. J. Popma, P. Berger, E. M. Ohman, R. A. Harrington, C. Grines, and J. I. Weitz Antithrombotic Therapy During Percutaneous Coronary Intervention: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 576S - 599S. [Abstract] [Full Text] [PDF]

				V. Schachinger, C. W. Hamm, T. Munzel, M. Haude, S. Baldus, E. Grube, T. Bonzel, T. Konorza, R. Koster, R. Arnold, et al. A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1360 - 1369. [Abstract] [Full Text] [PDF]

				J. M. t. Berg, B. A. Hutten, J. C. Kelder, F. W. A. Verheugt, and H. W. T. Plokker Oral Anticoagulant Therapy During and After Coronary Angioplasty : The Intensity and Duration of Anticoagulation Are Essential to Reduce Thrombotic Complications Circulation, April 24, 2001; 103(16): 2042 - 2047. [Abstract] [Full Text] [PDF]

				J. Orbe, J. A Rodriguez, A. Calvo, A. Grau, M. S Belzunce, D. Martinez-Caro, and J. A Paramo Vitamins C and E attenuate plasminogen activator inhibitor-1 (PAI-1) expression in a hypercholesterolemic porcine model of angioplasty Cardiovasc Res, February 1, 2001; 49(2): 484 - 492. [Abstract] [Full Text] [PDF]

				J. J. Popma, E. M. Ohman, J. Weitz, A. M. Lincoff, R. A. Harrington, and P. Berger Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention Chest, January 1, 2001; 119 (2009): 321S - 336S. [Full Text] [PDF]

				M P Heintzen, U E Heidland, W J Klimek, M Leschke, M Kelm, B Schwartzkopff, E G Vester, C J Michel, and B E Strauer Intracoronary dipyridamole reduces the incidence of abrupt vessel closure following PTCA: a prospective randomised trial Heart, May 1, 2000; 83(5): 551 - 556. [Abstract] [Full Text]

				K T Koch, J J Piek, M H Prins, R J de Winter, K Mulder, K I Lie, and J G P Tijssen Triage of patients for short term observation after elective coronary angioplasty Heart, May 1, 2000; 83(5): 557 - 563. [Abstract] [Full Text]

				B. J. Fredrickson, N. A. Turner, N. S. Kleiman, N. Graziadei, K. Maresh, M. A. Mascelli, M. B. Effron, and L. V. McIntire Effects of Abciximab, Ticlopidine, and Combined Abciximab/Ticlopidine Therapy on Platelet and Leukocyte Function in Patients Undergoing Coronary Angioplasty Circulation, March 14, 2000; 101(10): 1122 - 1129. [Abstract] [Full Text] [PDF]

				B. Jorgensen, S. Simonsen, K. Endresen, K. Forfang, K. Vatne, J. Hansen, J. Webb, C. Buller, G. Goulet, J. Erikssen, et al. Restenosis and clinical outcome in patients treated with amlodipine after angioplasty: results from the coronary AngioPlasty Amlodipine REStenosis Study (CAPARES) J. Am. Coll. Cardiol., March 1, 2000; 35(3): 592 - 599. [Abstract] [Full Text] [PDF]

				A. Cappelletti, A. Margonato, G. Rosano, A. Mailhac, F. Veglia, A. Colombo, and S. L. Chierchia Short- and long-term evolution of unstented nonocclusive coronary dissection after coronary angioplasty J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1484 - 1488. [Abstract] [Full Text] [PDF]

				A. Buffon, G. Liuzzo, L. M. Biasucci, P. Pasqualetti, V. Ramazzotti, A. G. Rebuzzi, F. Crea, and A. Maseri Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1512 - 1521. [Abstract] [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]

				M. Borries, M. Heins, Y. Fischer, H. Stiegler, A. Peters, H. Reinauer, F. C. Schoebel, B. E. Strauer, and M. Leschke Changes of hemostasis, endogenous fibrinolysis, platelet activation and endothelins after percutaneous transluminal coronary angioplasty in patients with stable angina J. Am. Coll. Cardiol., August 1, 1999; 34(2): 486 - 493. [Abstract] [Full Text] [PDF]

				P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]

				W. H. Matthai Jr., P. B. Kurnik, W. C. Groh, W. J. Untereker, and J. E. Siegel Antithrombin activity during the period of percutaneous coronary revascularization: Relation to heparin use, thrombotic complications and restenosis J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1248 - 1256. [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]

				R. Schrader, I. Esch, R. Ensslen, W. A. Fach, H. Merle, D. Scherer, H. Sievert, H. F. Spies, and H. E. Zeplin A randomized trial comparing the impact of a nonionic (iomeprol) versus an ionic (ioxaglate) low osmolar contrast medium on abrupt vessel closure and ischemic complications after coronary angioplasty J. Am. Coll. Cardiol., February 1, 1999; 33(2): 395 - 402. [Abstract] [Full Text] [PDF]

				S. M. Bates and J. I. Weitz Prevention of activation of blood coagulation during acute coronary ischemic syndromes: beyond aspirin and heparin Cardiovasc Res, February 1, 1999; 41(2): 418 - 432. [Abstract] [Full Text] [PDF]

				R. N. Piana, W. H. Ahmed, B. Chaitman, P. Ganz, S. Kinlay, J. Strony, B. Adelman, J. A. Bittl, and on behalf of the Hirulog Angioplasty Study Investi Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months J. Am. Coll. Cardiol., January 1, 1999; 33(1): 73 - 78. [Abstract] [Full Text] [PDF]

				S. G. Ellis, A. M. Lincoff, D. Miller, J. E. Tcheng, N. S. Kleiman, D. Kereiakes, R. Califf, E. J. Topol, and for the EPIC and EPILOG Investigators Reduction in complications of angioplasty with abciximab occurs largely independently of baseline lesion morphology J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1619 - 1623. [Abstract] [Full Text] [PDF]

				G. Dangas, J. J. Badimon, B. S. Coller, J. T. Fallon, S. K. Sharma, R. M. Hayes, P. Meraj, J. A. Ambrose, and J. D. Marmur Administration of Abciximab During Percutaneous Coronary Intervention Reduces Both Ex Vivo Platelet Thrombus Formation and Fibrin Deposition : Implications for a Potential Anticoagulant Effect of Abciximab Arterioscler Thromb Vasc Biol, August 1, 1998; 18(8): 1342 - 1349. [Abstract] [Full Text] [PDF]

				C. M. Gibson, M. Goel, D. J. Cohen, R. N. Piana, L. I. Deckelbaum, K. E. Harris, S. B. King III, and for the RESTORE Investigators Six-month angiographic and clinical follow-up of patients prospectively randomized to receive either tirofiban or placebo during angioplasty in the RESTORE trial J. Am. Coll. Cardiol., July 1, 1998; 32(1): 28 - 34. [Abstract] [Full Text] [PDF]

				C. R. Narins, D. R. Holmes Jr, and E. J. Topol A Call for Provisional Stenting : The Balloon Is Back! Circulation, April 7, 1998; 97(13): 1298 - 1305. [Full Text] [PDF]

				W. F. Baker JR Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I) Clinical and Applied Thrombosis/Hemostasis, January 1, 1998; 4(1): 51 - 75. [Abstract] [PDF]

				T. R. Investigators Effects of Platelet Glycoprotein IIb/IIIa Blockade With Tirofiban on Adverse Cardiac Events in Patients With Unstable Angina or Acute Myocardial Infarction Undergoing Coronary Angioplasty Circulation, September 2, 1997; 96(5): 1445 - 1453. [Abstract] [Full Text]

				D. L. Fischman and M. P. Savage The Platelet, the Patient, and Periprocedural Infarction During Percutaneous Transluminal Coronary Angioplasty JAMA, August 13, 1997; 278(6): 518 - 519. [Abstract] [PDF]

				D. R. Holmes Preventing Coronary Restenosis and Complications N. Engl. J. Med., June 12, 1997; 336(24): 1747 - 1749. [Full Text]

				S. Kaul, T. Z. Naqvi, M. C. Fishbein, B. Cercek, J. J. Badimon, T. C. Hutsell, S. Thomas, M. Molloy, and P. K. Shah Local Delivery of an Ultra-short-acting Nitric Oxide- releasing Compound, DMHD/NO, Is Highly Effective in Inhibiting Acute Platelet-Thrombus Formation on Injured Arterial Strips Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(3): 181 - 193. [Abstract] [PDF]

				L. Oltrona, P. R. Eisenberg, J. M. Lasala, D. J. Sewall, M. E. Shelton, and K. J. Winters Association of Heparin-Resistant Thrombin Activity With Acute Ischemic Complications of Coronary Interventions Circulation, November 1, 1996; 94(9): 2064 - 2071. [Abstract] [Full Text]

				J. A. Bittl Advances in Coronary Angioplasty N. Engl. J. Med., October 24, 1996; 335(17): 1290 - 1302. [Full Text] [PDF]

				D. B. Mark, J. D. Talley, E. J. Topol, L. Bowman, L. C. Lam, K. M. Anderson, J. G. Jollis, M. W. Cleman, K. L. Lee, T. Aversano, et al. Economic Assessment of Platelet Glycoprotein IIb/IIIa Inhibition for Prevention of Ischemic Complications of High-Risk Coronary Angioplasty Circulation, August 15, 1996; 94(4): 629 - 635. [Abstract] [Full Text]

				C. R. Narins, W. B. Hillegass Jr, C. L. Nelson, J. E. Tcheng, R. A. Harrington, H. R. Phillips, R. S. Stack, and R. M. Califf Relation Between Activated Clotting Time During Angioplasty and Abrupt Closure Circulation, February 15, 1996; 93(4): 667 - 671. [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]

				A. E. Abdelmeguid, P. L. Whitlow, S. K. Sapp, S. G. Ellis, and E. J. Topol Long-term Outcome of Transient, Uncomplicated In-Laboratory Coronary Artery Closure Circulation, June 1, 1995; 91(11): 2733 - 2741. [Abstract] [Full Text]

				The EPIC Investigators Use of a Monoclonal Antibody Directed against the Platelet Glycoprotein IIb/IIIa Receptor in High-Risk Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 956 - 961. [Abstract] [Full Text]

				C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]

				L. A. Harker Platelets and Vascular Thrombosis N. Engl. J. Med., April 7, 1994; 330(14): 1006 - 1007. [Full Text]