USEFULNESS OF QUANTITATIVE AND QUALITATIVE ANGIOGRAPHIC LESION MORPHOLOGY, AND CLINICAL CHARACTERISTICS IN PREDICTING MAJOR ADVERSE CARDIACEVENTS DURING AND AFTER NATIVE CORONARY BALLOON ANGIOPLASTY

Major, adverse cardiac events (death, myocardial infarction, bypass su rgery and reintervention) occur in 4 to 7% of all patients undergoing coronary balloon angioplasty. Prospectively collected clinical data, a nd angiographic quantitative and qualitative lesion morphologic assess ment and procedural factors were examined to determine whether the occ urrence of these events could be predicted. Of 1,442 patients undergoi ng balloon angioplasty for native primary coronary disease in 2 Europe an multicenter trials, 69 had major, adverse cardiac procedural or in- hospital complications after greater-than-or-equal-to balloon inflatio n and were randomly matched with patients who completed an uncomplicat ed in-hospital course after successful angioplasty. No quantitative an giographic variable was associated with major adverse cardiac events i n univariate and multivariate analyses. Univariate analysis showed tha t major adverse cardiac events were associated with the following cedu ral variables: (1) unstable angina (odds ratio [OR] 3.11; p < 0.0001), (2) type C lesion (OR 2.53; p < 0.004), (3) lesion location at a bend > 45-degrees (OR 2.34; p < 0.004), and (4) stenosis located in the mi ddle segment of the artery dilated (OR 1.88; p < 0.03); and with the f ollowing postprocedural variable: angiographically visible dissection (OR 5.39; p < 0.0001). Multivariate logistic analysis was per formed t o identify variables independently correlated with the occurrence of m ajor adverse cardiac events. The preprocedural multivariate model ente red unstable angina (OR 3.77; p < 0.0003), lesions located at a bend > 45-degrees (OR 2.87; p < 0.0005), and stenosis located in the middle portion of the artery dilated (OR 1.95; p < 0.04). If all variables we re included, then angiographically visible dissection (OR 6.58; p < 0. 0001), unstable angina (OR 3.46; p < 0.002) and lesions located at a b end > 45-degrees (OR 2.54; p < 0.006) were independent of major advers e cardiac events.