PCI complications: factors associated with complications

Changing Outcomes After PCI

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Editors-In-Chief: Alexandra Almonacid M.D. [1] and Jeffrey J. Popma M.D. [2]

Early Clinical Outcomes After PCI

• Anatomic Success: Residual diameter stenosis < 50 % which is generally associated with at least a 20 percent improvement in diameter stenosis and relief of ischemia.
• Pre-Stent Era: 72 – 74%.
• Stent Era: 82 – 98%
• Procedural Success: Angiographic success without the occurrence of major complications (death, MI, or CABG) within 30 days of the procedure.
• Clinical Success: Procedural success without the need for urgent repeat PCI or surgical revascularization within the first 30 days of the procedure

Variables Associated with Early Failure and Complications After PCI

• Clinical variables
  • Women
  • Advanced Age
  • Diabetes Mellitus
  • Unstable or Canadian Cardiovascular Society (CCS) Class IV angina
  • Congestive heart failure
  • Cardiogenic shock
  • Renal insufficiency
  • Preprocedural instability requiring intraaortic balloon pump support
  • Preprocedural Elevation of C-reactive protein
  • Multivessel Coronary Artery Disease
• Anatomic variables
  • Multivessel CAD
  • Left Main Disease
  • Thrombus
  • SVG intervention
  • ACC/AHA Type B2 and C lesion morphology
  • Chronic total coronary occlusion
• Procedural factors
  • A higher final percent diameter stenosis
  • Smaller minimal lumen diameter
  • Presence of a residual dissection or trans-stenotic pressure gradient

Risk Scores

Mayo Clinic Risk Score

Mayo Clinic Risk Score.Multivariate Predictors of Procedural Complication After PCI -3,264 pts undergoing PCI- Dynamic Registry at the National Heart, Lung, and Blood Institute. Adapted from Singh et al. J Am Coll Cardiol 2003; 42:1722-8

CADILLAC Risk Score

The Cadillac Risk Score: Integer Scoring System. From Halkin et al. J Am Coll Cardiol 2005; 45(9):1397-1405