How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby.
The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest-risk category complications can occur.
Brueren
B R
BR
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Mast
E G
EG
Suttorp
M J
MJ
Ernst
J M
JM
Bal
E T
ET
Plokker
H W
HW
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016507:Cardiology Service, Hospital / Q000592:standards; D002983:Clinical Competence; D017023:Coronary Angiography; D003327:Coronary Disease / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment / Q000592:standards* / Q000706:statistics & numerical data