Complications of Percutaneous Coronary Artery Intervention
Interventional cardiology encompasses an increasingly large number of patient and lesion subsets. Despite this factor, major complications of percutaneous coronary angioplasty (PCA) have gradually decreased. Data from large institutions published in 1988  reveal that the absolute risk of serious adverse events was already low (Fig. 13–1), so producing risk reductions was not an easy task. This reduction has been the result largely of a dramatic fall in the need for emergency or urgent coronary bypass graft surgery (from between 3% and 5% to about 0.5%) to treat acute or threatened closure after conventional balloon angioplasty [2,3]. Because acute or threatened closure was the most common major complication of intervention, substantial efforts were made to study the risk factors associated with it (Fig. 13–2). Some of these risk factors were demographic, whereas others were procedural [4,5]. With the widespread use of stent implantation (70% to 90% of patients undergoing PCA in North America and Europe), many of these factors may no longer be relevant.
Unable to display preview. Download preview PDF.
- 5.Scanion PJ, Faxon DP, Audet AM, et al.: ACC/AHA guidelines for coronary angiography: executive summary and recommendations. 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. Circulation 1999, 99:2345–2357.CrossRefGoogle Scholar
- 8.Garratt KN, Bacharach M: Stent retrieval: devices and technique. In Peripheral Vascular Stenting for Cardiologists. Edited by Heuser RR. London: Martin Dunitz; 1999:27.Google Scholar
- 10.Schuhlen H, Hadamitzky M, Walter H, et al.: Major benefit from antiplatelet therapy for patients at high risk for adverse cardiac events after coronary Palmaz-Schatz stent placement: analysis of a prospective risk stratification protocol in the Intracoronary Stenting and Antithrombotic Regimen (ISAR) trial. Circulation 1997, 95:2015–2021.PubMedCrossRefGoogle Scholar
- 13.Waksman R, Ajani AE, White RL, et al.: Prolonged antiplatelet therapy to prevent late thrombosis after intracoronary gamma-radiation in patients with in-stent restenosis: Washington Radiation for In-Stent Restenosis Trial plus 6 months of Clopidogrel (WRIST PLUS). Circulation 2001, 103:2332–2335.PubMedCrossRefGoogle Scholar
- 23.McClure MW, Berkowitz SD, Sparapani R, et al.: Clinical significance of thrombocytopenia during a non-ST-elevation acute coronary syndrome. The platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (PURSUIT) trial experience. Circulation 1999, 99:2892–900.PubMedCrossRefGoogle Scholar
- 32.Scanlon PJ, Faxon DP, Audet AM, et al.: ACC/AHA guidelines for coronary angiography: executive summary and recommendations. 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. Circulation 1999, 99:2345–2357.PubMedCrossRefGoogle Scholar
- 36.Ellis SG, Guetta V, Miller D, et al.: 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 1999, 100:1971–1976.PubMedCrossRefGoogle Scholar