VALUE OF THE AMERICAN-COLLEGE-OF-CARDIOLOGY AMERICAN-HEART-ASSOCIATION STENOSIS MORPHOLOGY CLASSIFICATION FOR CORONARY INTERVENTIONS IN THELATE 1990S

The goal of this study was to reassess the accuracy of the American Co llege of Cardiology/American Heart Association (ACC/AHA) stenosis morp hology classification for predicting coronary intervention success and complications in the era of new devices. Previous studies performed i n the early part of this decade for percutaneous transluminal coronary angioplasty in patients with multivessel coronary artery disease foun d that these criteria were predictive of success rates but not complic ation rates. Data for 957 consecutive coronary interventions in 1,404 lesions from June 1994 to October 1996 were prospectively classified a ccording to ACC/AHA guidelines and entered into a database. Ninety-one and 9/10 of coronary interventions were successful, defined as <50% r esidual stenosis of each vessel attempted in the absence of major in-h ospital complications, including Q-wave myocardial infarction, ventric ular arrhythmia, need for emergency coronary artery bypass surgery, or death. Success rates did not differ between A (186 of 193, 96.3%), B1 (211 of 221, 95.5%), and B2 (676 of 711, 95.1%) lesions, but each was more successful than C (246 of 279, 88.2%) lesions (p <0.003, p < 0.0 04, and p = 0.0001, respectively), The class of lesion (A, B, or C) di d not predict device (atherectomy, rotablator, and stent) use but spec ific morphologic characteristics of lesions within these classes were predictive of which device was used. Multiple regression analysis reve aled that total occlusion and vessel tortuosity were predictive of pro cedure failure. Lesion type (A, B, or C) was not predictive of complic ations, but bifurcation lesions (p = 0.0045), presence of thrombus (p = 0.0001), inability to protect a major side branch (p = 0.0468), and degenerated vein graft lesions (p = 0.0283) were predictive. Thus, the ACC/AHA grading system is predictive of successful coronary intervent ion outcome, particularly of C-type characteristics, but not of compli cations or device success rate and selection. Although lesion type (A, B, or C) was not predictive of complications, specific lesion morphol ogies were predictive of adverse events and device use. (C) 1998 by Ex cerpta Medica, Inc.