PCI complications: factors associated with complications

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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

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