title: Failed percutaneous coronary intervention: a decade of experience in 21,000 patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incidence, mechanisms, and in-hospital outcomes after failed percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The most common causes of PCI failure are severe dissection, no-reflow, and uncrossable total occlusions.
  
  
  METHODS
  Demographic, clinical, procedural, and quality assurance data were recorded in a prospective database to determine the incidence and outcome of failed PCI. Data were analyzed according to the year of PCI: prestent era (PSE 1993-1995), first generation stent era (FGSE 1996-2000), and contemporary stent era (CSE 2000-2003).
  
  
  RESULTS
  PCI (20,884) were performed over a 10-year-period from 1993 through 2003, including 4,344 (20.8%) in the PSE, 9,114 (43.6%) in the FGSE, and 7,426 (35.6%) in the CSE; 19,171 (91.8%) were successful and 1,704 (8.2%) were failures. Nearly 90% of PCI failures are due to no-reflow or uncrossable total occlusions. Among PCI failures, 7.5% were treated medically and 0.7% required emergency coronary artery bypass grafting (ECABG). PCI success was independently associated with PCI during CSE (OR 1.86, P < 0.0001). ECABG decreased sixfold from 1.2% in the PSE to 0.2% in the CSE.
  
  
  CONCLUSIONS
  Contemporary PCI patients have better procedural outcomes and fewer in-hospital adverse events than patient treated before the availability of stents. However, recanalization of total occlusions and avoiding no-reflow will have the most impact on future PCI success.
authors.affiliation: The Division of Cardiology, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Mattichak
authors.forename: Simon R
authors.initials: SR
authors.lastname: Dixon
authors.forename: Francis
authors.initials: F
authors.lastname: Shannon
authors.forename: Judith A
authors.initials: JA
authors.lastname: Boura
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054318:No-Reflow Phenomenon / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure