Predicting the risk of abrupt vessel closure after angioplasty in an individual patient

Tulane University Medical Center, New Orleans, Louisiana.

OBJECTIVES. We proposed to examine the relation between angiographic morphologic characteristics and abrupt closure after coronary angioplasty and to develop an empirically based risk stratification system. BACKGROUND. Certain lesion morphologic characteristics are associated with higher rates of abrupt closure after coronary angioplasty. Previous approaches have been limited by relatively small sample sizes and an inability to combine multiple characteristics to predict risk in an individual patient. METHODS. Lesion morphology was determined for 779 lesions in 658 patients undergoing an elective first angioplasty. Abrupt closure occurred in 63 lesions (8.1%). Variables associated with abrupt closure were identified by univariate and stepwise multiple logistic regression analysis, and internal validity was assessed by use of bootstrapping. An empirically based scoring system was developed by assigning different weights to each predictive characteristic and was then validated. RESULTS. Almost all lesion characteristics previously labeled "adverse" were associated with an increased risk of abrupt closure, but only total occlusion, location at a branch point, increasing lesion length, evidence for thrombus and right coronary artery location were statistically significant independent predictors. Despite the large sample size, the study was underpowered to detect even a 50% increase in risk with many characteristics. Using a scoring system, we assigned each lesion a specific risk of abrupt closure. The distribution of risk was broad, with 20% of patients having < or = 2.5% risk and 25% having > 10% risk. Internal validation techniques revealed that when 10% of patients were randomly eliminated from the sample in multiple iterations, the risk estimates varied, again pointing to the need for a larger sample. CONCLUSIONS. Empirically based weighting of lesion characteristics could quantify the risk of abrupt closure for individual patients, but a very large sample will be required to understand the interplay of complex lesion characteristics in altering expected outcomes.

This article has been cited by other articles:

				W. A. Gray and J. F. Granada Drug-Coated Balloons for the Prevention of Vascular Restenosis Circulation, June 22, 2010; 121(24): 2672 - 2680. [Full Text] [PDF]

				E. Cheneau, L. Leborgne, G. S. Mintz, J.-i. Kotani, A. D. Pichard, L. F. Satler, D. Canos, M. Castagna, N. J. Weissman, and R. Waksman Predictors of Subacute Stent Thrombosis: Results of a Systematic Intravascular Ultrasound Study Circulation, July 8, 2003; 108(1): 43 - 47. [Abstract] [Full Text] [PDF]

				A. Kawaguchi, K. Mitsudo, M. Nobuyoshi, R. Minamino, K. Hayasaki, M. Nakashima, and A. Yamamoto Angiographic Intervention Trial Using Hmg Coa Reductase Inhibitor to Evaluate Retardation of Obstructive Multiple Atheroma in West Japan (ATHEROMA Study): Rationale, Design and Baseline European Journal of Cardiovascular Prevention & Rehabilitation, February 1, 2002; 9(1): 7 - 16. [Abstract] [PDF]

				M. Singh, G. S. Reeder, E. M. Ohman, V. Mathew, W. B. Hillegass, R. D. Anderson, D. S. Gallup, K. N. Garratt, and D. R. Holmes Jr Does the presence of thrombus seen on a coronary angiogram affect the outcome after percutaneous coronary angioplasty? An angiographic trials pool data experience J. Am. Coll. Cardiol., September 1, 2001; 38(3): 624 - 630. [Abstract] [Full Text] [PDF]

				K M Akkerhuis, M J B M van den Brand, C van der Zwaan, H O J Peels, H Suryapranata, L R van der Wieken, J Stibbe, J Hoffmann, T Baardman, J W Deckers, et al. Pharmacodynamics and safety of lefradafiban, an oral platelet glycoprotein IIb/IIIa receptor antagonist, in patients with stable coronary artery disease undergoing elective angioplasty Heart, April 1, 2001; 85(4): 444 - 450. [Abstract] [Full Text]

				W. Maier, O. Mini, J. Antoni, M. B. Wischnewsky, and B. Meier ABC Stenosis Morphology Classification and Outcome of Coronary Angioplasty : Reassessment With Computing Techniques Circulation, March 6, 2001; 103(9): 1225 - 1231. [Abstract] [Full Text] [PDF]

				K. Fitch, P. Lazaro, M. D. Aguilar, J. P. Kahan, M. van het Loo, and S. J. Bernstein European criteria for the appropriateness and necessity of coronary revascularization procedures Eur J Cardiothorac Surg, October 1, 2000; 18(4): 380 - 387. [Abstract] [Full Text] [PDF]

				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]

				E. A. Iliadis, S. M. Zaacks, J. E. Calvin, J. Allen, J. E. Parrillo, and L. W. Klein The Relative Influence of Lesion Length and Other Stenosis Morphologies on Procedural Success of Coronary Intervention Angiology, January 1, 2000; 51(1): 39 - 52. [Abstract] [PDF]

				S. G. Ellis, V. Guetta, D. Miller, P. L. Whitlow, and E. J. Topol Relation Between Lesion Characteristics and Risk With Percutaneous Intervention in the Stent and Glycoprotein IIb/IIIa Era : An Analysis of Results From 10 907 Lesions and Proposal for New Classification Scheme Circulation, November 9, 1999; 100(19): 1971 - 1976. [Abstract] [Full Text] [PDF]

				G. T. O'Connor, D. J. Malenka, H. Quinton, J. F. Robb, M. A. Kellett Jr., S. Shubrooks, W. A. Bradley, M. J. Hearne, M. W. Watkins, D. E. Wennberg, et al. Multivariate prediction of in-hospital mortality after percutaneous coronary interventions in 1994-1996 J. Am. Coll. Cardiol., September 1, 1999; 34(3): 681 - 691. [Abstract] [Full Text] [PDF]

				H. Schunkert, L. Harrell, and I. F. Palacios Implications of small reference vessel diameter in patients undergoing percutaneous coronary revascularization J. Am. Coll. Cardiol., July 1, 1999; 34(1): 40 - 48. [Abstract] [Full Text] [PDF]

				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]

				R. M. Califf, J. G. Jollis, and E. D. Peterson Operator-Specific Outcomes : A Call to Professional Responsibility Circulation, February 1, 1996; 93(3): 403 - 406. [Full Text]

				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]