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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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Article Info
Publication History
Accepted:
July 20,
1991
Received in revised form:
July 19,
1991
Received:
January 14,
1991
Identification
Copyright
© 1991 Published by Elsevier Inc.
