How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby

• Published in: Catheterization and cardiovascular interventions Vol. 46; no. 3; pp. 257 - 262
• Main Authors: Brueren, B.R.G., Mast, E.G., Suttorp, M.J., Ernst, J.M.P.G., Bal, E.T., Plokker, H.W.M.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.03.1999
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Cardiology Service, Hospital - standards; Clinical Competence; Coronary Angiography; Coronary Disease - classification; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Coronary Disease - therapy; Female; Humans; Male; Middle Aged; Myocardial Revascularization; Netherlands; Outcome Assessment (Health Care) - standards; Outcome Assessment (Health Care) - statistics & numerical data; percutaneous transluminal coronary angioplasty; Prospective Studies; risk; Risk Assessment - standards; Risk Assessment - statistics & numerical data; surgical standby
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/(SICI)1522-726X(199903)46:3<257::AID-CCD1>3.0.CO;2-9

The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest‐risk category complications can occur. Cathet. Cardiovasc. Intervent. 46:257–262, 1999. © 1999 Wiley‐Liss, Inc.