IMMEDIATE OUTCOME FOLLOWING CORONARY ANGIOPLASTY - A CONTEMPORARY SINGLE-CENTER AUDIT

To study the in-hospital outcome of all coronary angioplasty procedure s performed in a single centre over a 1 year period with regard to ang iographic success and the clinical complications of death, myocardial infarction, emergency coronary bypass surgery and abrupt coronary occl usion necessitating reintervention. Methods: One thousand one hundred and thirty-three lesions were treated in 970 procedures in 799 patient s between October 1993 and October 1994. Clinical, procedural, angiogr aphic and outcome data were entered into a dedicated computer database and variables tested with respect to outcome using the chi-square tes t and univariate and multivariate analysis techniques. Results: Angiop lasty was performed for stable angina in 473 (49%) patients, unstable angina in 410 (42%) and 80 procedures were emergency-primary myocardia l infarction in 44 (4 . 5%), shock in two, abrupt closure in 34 (3 . 5 %) and other indications in seven patients. There were 10 (1 . 0%) dea ths and 71 (7 . 3%) patients were documented to have suffered a myocar dial infarction as a result of angioplasty. Nineteen (2 . 0%) patients underwent emergency coronary artery bypass surgery. Age >60 and a typ e C lesion were found to be associated with angiographic failure. The chance of a complication was increased if the patient was aged >60 yea rs, suffered unstable angina, had an ejection fraction <50%, was treat ed with a new device or suffered a significant dissection. Conclusion: Despite refinement in techniques and increased experience, coronary a ngioplasty retains a significant associated chance of angiographic fai lure. The complication rate remains significant and there has been lit tle reduction in mortality, infarction and abrupt closure rates over t he last 15 years. The requirement for emergency coronary artery bypass surgery appears to be diminishing with the introduction of improved b ail-out techniques, in particular intracoronary stenting.