Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience

Department of Cardiology, Guy's Hospital, London, England, United Kingdom.

OBJECTIVES. This study evaluated the validity of the American College of Cardiology/American Heart Association ABC lesion classification scheme and its modifications. BACKGROUND. With the continued refinement in angioplasty technique and equipment evolution, the lesion morphologic determinants of immediate angioplasty outcome have changed significantly. Hence, the validity of the classification scheme has been questioned. METHODS. We assessed the lesion morphologic determinants of immediate angioplasty outcome in 729 consecutive patients who underwent coronary angioplasty of 994 vessels and 1,248 lesions. RESULTS. Angioplasty success was achieved in 91% of lesions, and abrupt closure occurred in 3%. Success was achieved in 96%, 93% and 80% of type A, B and C lesions, respectively (A vs. B, p = NS; B vs. C, p < 0.001; A vs. C, p < 0.001; A vs. B1, p = NS; A vs. B2, p = 0.03; B1 vs. B2, p = 0.02; B2 vs. C, p < 0.001; C1 vs. C2, p = NS). Abrupt closure occurred in 2.1%, 2.6% and 5% of type A, B and C lesions, respectively (A vs. B, B vs. C, A vs. C and A vs. B1, all p = NS; B1 vs. B2, p = 0.01; B2 vs. C1, p = NS; C1 vs. C2, p = 0.04). Type B characteristics had a success rate ranging from 74% to 95% and an abrupt closure rate ranging from 2.2% to 14%. Type C characteristics had a success rate ranging from 57% to 88% and an abrupt closure rate ranging from 0% to 16%. Longer lesions, calcified lesions, diameter stenosis of 80% to 99% and presence of thrombus were predictive of a lower success rate. Longer lesions, angulated lesions, diameter stenosis of 80% to 99% and calcified lesions were predictive of an abrupt closure. CONCLUSIONS. The previously proposed classification schemes are outdated and need to be changed for application in current angioplasty practice. Analyzing specific lesion morphologic characteristics rather than applying a simple lesion classification score when evaluating angioplasty outcome may be more useful because it provides a more precise profile of the lesion and allows better patient stratification and selection.

This article has been cited by other articles:

				E. I. Kapetanakis, D. A. Medlam, K. R. Petro, E. Haile, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, and P. J. Corso Effect of Clopidogrel Premedication in Off-Pump Cardiac Surgery: Are We Forfeiting the Benefits of Reduced Hemorrhagic Sequelae? Circulation, April 4, 2006; 113(13): 1667 - 1674. [Abstract] [Full Text] [PDF]

				T Nageh, R A Sherwood, B M Harris, and M R Thomas Prognostic role of cardiac troponin I after percutaneous coronary intervention in stable coronary disease Heart, September 1, 2005; 91(9): 1181 - 1185. [Abstract] [Full Text] [PDF]

				J. T. Willerson Myocardial Revascularization with Cardiologic Interventional Devices Card. Surg. Adult, January 1, 2003; 2(2003): 561 - 580. [Full Text]

				D. P. Chew, D. L. Bhatt, M. A. Robbins, M. S. Penn, J. P. Schneider, M. S. Lauer, E. J. Topol, and S. G. Ellis Incremental Prognostic Value of Elevated Baseline C-Reactive Protein Among Established Markers of Risk in Percutaneous Coronary Intervention Circulation, August 28, 2001; 104(9): 992 - 997. [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]

				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 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]

				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]

				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]

				A. Kastrati, A. Schomig, S. Elezi, J. Dirschinger, J. Mehilli, H. Schuhlen, R. Blasini, and F.-J. Neumann Prognostic Value of the Modified American College of Cardiology/American Heart Association Stenosis Morphology Classification for Long-Term Angiographic and Clinical Outcome After Coronary Stent Placement Circulation, September 21, 1999; 100(12): 1285 - 1290. [Abstract] [Full Text] [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]

				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]

				S. Waxman, M. A. Sassower, M. A. Mittleman, S. Zarich, A. Miyamoto, K. S. Manzo, J. E. Muller, G. S. Abela, and R. W. Nesto Angioscopic Predictors of Early Adverse Outcome After Coronary Angioplasty in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction Circulation, June 15, 1996; 93(12): 2106 - 2113. [Abstract] [Full Text]

				R. L. Geary, J. K. Williams, D. Golden, D. G. Brown, M. E. Benjamin, and M. R. Adams Time Course of Cellular Proliferation, Intimal Hyperplasia, and Remodeling Following Angioplasty in Monkeys With Established Atherosclerosis : A Nonhuman Primate Model of Restenosis Arterioscler. Thromb. Vasc. Biol., January 1, 1996; 16(1): 34 - 43. [Abstract] [Full Text]