MYOCARDIAL-INFARCTION AS A COMPLICATION OF NEW INTERVENTIONAL DEVICES

Percutaneous transluminal coronary balloon angioplasty has been associ ated with acute myocardial infarction (MI) as a complication of the pr ocedure. Abrupt closure, distal coronary embolization, intimal dissect ion, coronary spasm, and acute thrombosis are the principal etiologies . New interventional devices (stent, laser, and atherectomy catheters) have been introduced as alternatives or adjuncts to balloon angioplas ty. With use of the New Approaches to Coronary Intervention Registry, the incidence, predictors, and outcome of MI as a complication of usin g these devices as the primary mode of intervention were studied. Ther e were 3,265 patients from 39 participating centers in the cohort trea ted with new devices. MI was reported as an in-hospital complication o f using new devices in 154 patients (4.7%), including Q-wave MI in 36 patients (1.1%), and non-Q-wave MI in 119 patients (3.6%). MI rates we re not significantly different among all patients with devices ire the cohort treated with atherectomy (directional, extractional, rotationa l), laser (AIS, Spectranetics) or the Palmaz-Schatz stent. Multivariat e logistic regression showed that post-procedure MI was associated wit h multivessel disease, high surgical risk, postinfarction angina, and presence of a thrombus prior to the procedure. Prior percutaneous tran sluminal coronary angioplasty was inversely related to the incidence o f MI. When a specific cause of MI could be detected, the main etiologi es were: coronary embolus 16.9%, and abrupt closure 27.3%. Other major in-hospital complications were higher in the MI group than the non-MI group: death 7.8% versus 0.8% (p < 0.001), and bypass surgery 13.6% v ersus 1.7% (p < 0.001). At 1 year, mortality rates remain higher at 12 .9% in the MI group versus 4.9% in the non-MI group (p < 0.01). Despit e different indications for the use of new devices, they were not pred ictors for MI with the exception of the rotablator. The incidence of M I (1.1% Q-wave, 3.6% non-Q-wave) was comparable to previously reported rates for balloon angioplasty. The occurrence of MI is associated wit h an increase in other in-hospital complications and a doubling of 1-y ear mortality.