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.