Frequency of abrupt vessel closure and side branch occlusion after percutaneous coronary intervention in a 6.5-year period (1994 to 2000) at a single medical center.
The aims of this study were to analyze the contemporary trends in the changing incidence of abrupt vessel closure (AVC) after percutaneous coronary intervention (PCI), to determine the impact of intracoronary stenting and glycoprotein IIb/IIIa inhibitors (GPIs) on complication rates and etiologies, and to determine the incidence of side branch occlusion (SBO) as the etiology of AVC in the stent era, complications occurring during 3,300 consecutive PCIs performed from April 1994 to December 2000 at a single referral institution. In this consecutive patient cohort of PCI cases collected over a 6.5-year period, AVC occurred in 103 of 3,300 cases (3.12%). Linear regression analysis over this time frame documented a steadily decreasing incidence of AVC from 5.9% in 1994 to 1.1% in 2000 (-0.76%/per year, 95% confidence interval -0.99 to 0.52, p <0.05). Analysis using Pearson's correlation showed that the decreasing incidence of AVC was inversely correlated with the increasing percentage of intracoronary stents placed over this time period (r = -0.94, p <0.001). Additionally, GPI use increased from 0% in 1995 to 36.0% in 2000 (p = 0.009). The absolute incidence of SBO of a major branch vessel remained relatively stable over this 6.5-year period. However, SBO appeared to be increasing as the etiology of AVC, and accounted for 9.0% of AVC in 1995 compared with 28.0% of AVC in 2000. This increasing trend of the percentage of SBO as the etiology of AVC appeared to correlate with the increased use of stents (r = 0.85, p = 0.015). Thus, the incidence of AVC steadily decreased over the 6.5-year time period, and was associated with the increased use of stents and GPIs; conversely, SBO accounted for an increasing percentage of AVC over this time period.
Almeda
Francis Q
FQ
Rush University Medical Center, Rush Heart Institute, and Rush Medical College, Chicago, Illinois, USA.
Nathan
Sandeep
S
Calvin
James E
JE
Parrillo
Joseph E
JE
Klein
Lloyd W
LW
D000046:Academic Medical Centers; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology*; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012044:Regression Analysis; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex