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Causes and correlates of death after unsupported coronary angioplasty: Implications for use of angioplasty and advanced support techniques in high-risk settings

  • Stephen G. Ellis
    Correspondence
    Address for reprints: Stephen Ellis, MD, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195.
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Richard K. Myler
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Spencer B. King III
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • John S. Douglas Jr.
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Eric J. Topol
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Richard E. Shaw
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Simon H. Stertzer
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Gary S. Roubin
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
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  • Mary C. Murphy
    Affiliations
    From The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    From The San Francisco Heart Institute, Seton Medical Center, Daly City, California, USA

    From the Emory University School of Medicine, Atlanta, Georgia USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      To better understand the factors predisposing a patient to death after elective percutaneous transluminal coronary angioplasty (PTCA) and to gain insight into indications for high-risk PTCA both with and without adjunctive use of support devices, the outcomes of 8,052 consecutive procedures were reviewed. Death occurred after 32 procedures (0.4%) and was directly related to coronary artery closure in 26 (81%) of these cases. Left ventricular failure due to vessel closure at the dilated site, the most common cause of death, was independently correlated with female sex (p < 0.001), “jeopardy score” (p < 0.001) and PTCA of a proximal right coronary artery site (p = 0.002), but not with left ventricular ejection fraction or presence of multivessel disease. Right ventricular failure after closure of the proximal right coronary artery, and left main coronary dissection accounted for the majority of the remaining deaths. Systolic blood pressure immediately after coronary artery closure was also closely correlated with jeopardy score, and cardiogenic shock was frequent in women with scores ≥3.5 and in men with scores ≥5.0. These data highlight the superiority of the jeopardy score versus ejection fraction in the determination of risk, stress the importance of gender in determining outcome and point to the need for better means of right ventricular protection from severe ischemia. Therefore, an initial framework for rational use of PTCA and support devices in the high-risk setting is established.
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