LONG-TERM OUTCOME OF TRANSIENT, UNCOMPLICATED IN-LABORATORY CORONARY-ARTERY CLOSURE

Background Successful reversal of abrupt vessel closure without result ant major ischemic complications (death, Q-wave myocardial infarction, or coronary artery bypass graft surgery) is achieved in nearly half o f all cases of abrupt vessel closure. The long-term outcome of these p atients has not been previously addressed, and it is not clear whether they have a different prognosis than that of patients who have a succ essful procedure not associated with transient vessel closure. Methods and Results We examined 4863 consecutive patients who underwent succe ssful percutaneous transluminal coronary angioplasty (PTCA) or directi onal coronary atherectomy (DCA). Eighty-eight patients had an uncompli cated, successfully reversed transient in-laboratory vessel closure (g roup 2) and were compared with 4775 patients who had a successful proc edure not associated with transient in-laboratory closure (group I). C linical follow-up was available in 4839 patients (99.5%), with a mean duration of 41+/-23 months (range, 1 to 104 months). Survival analysis showed that successfully treated, uncomplicated transient vessel clos ure per se does not have an adverse effect on long-term prognosis (dea th, myocardial infarction, or coronary interventions). However, when t he procedure (PTCA or DCA) was associated with an increase in creatine kinase-MB (CK-MB), there was a significant adverse effect on long-ter m outcome. By multivariate logistic regression, an increase in postpro cedure CK-MB was the most significant correlate for cardiac death (ris k ratio, 1.25; P<.0001). An increase in CK-MB was also the most import ant correlate for major ischemic complications (death, infarction, or coronary interventions) on follow-up (risk ratio, 1.08; P=.0005). Conc lusions Transient, uncomplicated in-laboratory vessel closure per se d oes not have an adverse long-term effect. However, a concomitant eleva tion of postprocedure cardiac enzymes has an important and significant adverse effect on long-term outcome. This study suggests that peripro cedural creatine kinase isoenzyme determination in patients experienci ng in-laboratory coronary closure has important prognostic implication s.