A simplified lesion classification for predicting success and complications of coronary angioplasty

In 1988, the American College of Cardiology/American Heart Association (ACC /AHA) Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures presented a classification of coronary lesions utilizing 26 les ion features to predict the success and complications of balloon angioplast y. Using data from the Registry of the Society for Cardiac Angiography and Interventions (SCAI) we evaluated the ability of this classification to pre dict success and complications. Lesion success, death in hospital, emergenc y cardiac bypass surgery, and major adverse events were evaluated in 41,071 patients who underwent single-vessel angioplasty from January 1993 to June 1996. Logistic models using the ACC/AHA lesion classification, vessel pate ncy, or both, were compared. A new classification based on the interaction of the ACC/AHA classification plus lesion patency was compared with the exi sting ACC/AHA classification. Vessel patency, added to the ACC/AHA classifi cation, improved prediction of lesion success (p less than or equal to 0.00 01). Class A and patent B lesions had similar success and complication rate s, so a simplified classification (SCAI) using only 7 lesion characteristic s could be created. This system (I: non-C patent, II: C patent, III: non-C occluded, and IV: C occluded) improved prediction of lesion success compare d with the ACC/AHA classification (Bayesian Information Criterion statistic : ACC/AHA 16539, SCAI 15956; and area under the receiver-operating characte ristics curve 0.659, 0.693, respectively). The SCAI classification was pref erred for predicting major complications and in-hospital death and was simi lar to the ACC/AHA classification for predicting emergency bypass surgery. (C) 2000 by Excerpta Medica, Inc.