Risk predictors in patients scheduled for percutaneous coronary revascularization

Traditionally, procedural risks associated with conventional balloon corona ry angioplasty have been largely attributed to unfavorable lesion morpholog y. However, factors predicting adverse events in the current practice of pe rcutaneous coronary revascularization are unclear. The present study was un dertaken to determine factors predicting major adverse events (death or Q-w ave myocardial infarction or emergency bypass surgery) in 3,335 consecutive patients undergoing percutaneous coronary revascularization in the current practice of percutaneous coronary revascularization. During the period of observation, the rate of lesions treated successfully increased from 91% to 95% (P < 0.0001), whereas the rate of major adverse events (MACE) decrease d from 3.6% to 1.6% (odds ratio [OR], 0.70 per year). Using multiple stepwi se logistic regression analysis, cardiogenic shock (OR, 8.59; confidence in terval [CI], 4.27-17.27), renal disease (OR, 3.33; CI, 1.95-5.69), evolving myocardial infarction (OR, 2.80; CI, 1.47-5.31), congestive heart failure (OR, 2.18; CI, 1.23-3.86), total number of lesions treated (OR, 1.28; CI, 1 .03-1.591, age (OR, 1.03; CI, 1.01-1.06), and history of prior coronary int ervention (OR, 0.51; CI 0.26-0.99) were identified as independent predictor s of MACE. In addition, vascular disease (OR, 2.48; CI 1.37-4.50) and unsta ble angina pectoris (OR, 0.44; CI 0.25-0.79) were related to adverse events when patients in cardiogenic shock were excluded from the model. With the exception of most unfavorable lesion morphology (AHA/ACC lesion type C; OR, 2.05; CI, 1.19-3.52), anatomic parameters added no further information. In the present era of device technology, success rates of percutaneous corona ry revascularization procedures have increased and remain to be determined by lesion morphology. In contrast, the rate of MACE is declining and best p redicted by easily identified patient characteristics. Cathet. Cardiovasc. Intervent. 48:253-264 1999. (C) 1999 Wiley-Liss, Inc.