RECENT CHANGES IN THE MANAGEMENT AND OUTCOME OF ACUTE CLOSURE AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

The major cause of morbidity and mortality associated with percutaneou s transluminal coronary angioplasty (PTCA) is acute closure. This stud y compared the clinical outcome of 2 groups of patients who experience d acute closure during PTCA. One group was treated during a period whe n intracoronary stents, laster balloons and perfusion balloons were av ailable for treatment of acute closure (group II). These results were compared with the clinical outcome a group of similar patients who wer e treated for acute closure during a period that immediately preceded the availability of these devices (group I). One hundred sixty-six pat ients had acute closure in group I, whereas 156 patients experienced a cute closure in group II. Baseline clinical characteristics were simil ar for both groups. There was no difference in ejection fraction, numb er of vessels diseased, degree of stenosis or number of vessels attemp ted between the 2 groups. Patients in group II had more balloon inflat ions and longer balloon inflation times when compared with patients in group I. Of the 156 patients in group II, 47% were treated with eithe r an intracoronary stent, laser balloon or perfusion balloon. Group II patients had fewer Q-wave myocardial infarctions (9.1 vs 20.3%, p = 0 .005). In addition, peak creatine phosphokinase levels (826 +/- 1,515 vs 517 +/- 1,050, p <0.01) and mean residual stenosis (40.7 +/- 33.2 v s 58.0 +/- 34.4%, p <0.0001) were also lower in group II patients. The re was also less coronary artery bypass grafting during the same admis sion (38.6 vs 29.5%, p = 0.02) in group II patients. These data sugges t that there has been a recent improvement in the clinical outcome of patients with acute closure. This improvement may be related to a more aggressive use of prolonged inflation with standard balloons, in addi tion to the use of intracoronary stents, laser balloons and perfusion balloons.