Evolving Strategies and Implications

In this issue of Circulation, Detre et all review the incidence and outcome of periprocedural coronary artery occlusion following percutaneous transluminal coronary angioplasty (PTCA) in the second phase of the National Heart, Lung, and Blood Institute's (NHLBI) PTCA Registry. This registry examined the results in 1,801 patients managed during 1985-1986 with an initial PTCA not in the setting of acute myocardial infarction (MI) from 15 experienced centers. Periprocedural occlusion was observed in 122 (6.8%) patients, with 72% of occlusions occurring while the patient was still in the cardiac catheterization laboratory (4.9% incidence) and 28% of occlusions occurring outside the catheterization laboratory following initially successful PTCA (1.9% incidence). Independent predictors of periprocedural occlusion included the following: 1) patients at "high" surgical risk; 2) patients with acute coronary insufficiency; 3) patients with three-vessel coronary artery disease; 4) pre-PTCA coronary arterial diameter stenosis .90%; 5) dilatation of coronary artery segments with diffuse disease, multiple discrete lesions, intraluminal thrombus, or ones that supplied collateral flow to other vessels; and 6) presence of an intimal tear or dissection following PTCA.