In-hospital cardiac mortality after acute closure after coronary angioplasty: Analysis of risk factors from 8,207 procedures
- 1 February 1988
- journal article
- research article
- Published by Elsevier BV in Journal of the American College of Cardiology
- Vol. 11 (2), 211-216
- https://doi.org/10.1016/0735-1097(88)90082-4
Abstract
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 190 patients randomly chosen, in whom vessel closure after angioplasty did not result in death during hospitalization. Univariate analysis found female gender (p < 0.0001), collateral channels from the vessel dilated (p < 0.0001), use of balloon counterpulsation (p < 0.0002), pre- and postprocedural hypotension (p = 0.0003 and p = 0.003, respectively), jeopardy score ≥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 publication has 13 references indexed in Scilit:
- In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.Circulation, 1985
- Prognostic value of a coronary artery jeopardy scoreJournal of the American College of Cardiology, 1985
- The plights of the invasive treatment of ischemic heart diseaseJournal of the American College of Cardiology, 1985
- Acute coronary events associated with percutaneous transluminal coronary angioplastyThe American Journal of Cardiology, 1984
- Risk of side branch occlusion during coronary angioplastyThe American Journal of Cardiology, 1984
- Assessment of stenoses in coronary angioplasty. Inter- and intraobserver variabilityInternational Journal of Cardiology, 1983
- Decreased Coronary ReserveNew England Journal of Medicine, 1982
- Clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS).Cell Metabolism, 1981
- Quantitative study on the size of coronary artery supplying areas postmortemAmerican Heart Journal, 1977
- Anatomy of the Coronary Arteries in Health and DiseaseCirculation, 1965