Recent changes in the management and outcome of acute closure after percutaneous transluminal coronary angioplasty

The major cause of morbidity and mortality associated with percutaneous transluminal coronary angioplasty (PTCA) is acute closure. This study compared the clinical outcome of 2 groups of patients who experienced acute closure during PTCA. One group was treated during a period when intracoronary stents, laser balloons and perfusion balloons were available for treatment of acute closure (group II). These results were compared with the clinical outcome a group of similar patients who were treated for acute closure during a period that immediately preceded the availability of these devices (group I). One hundred sixty-six patients had acute closure in group I, whereas 156 patients experienced acute closure in group II. Baseline clinical characteristics were similar for both groups. There was no difference in ejection fraction, number of vessels diseased, degree of stenosis or number of vessels attempted between the 2 groups. Patients in group II had more balloon inflations and longer balloon inflation times when compared with patients in group I. Of the 156 patients in group II, 47% were treated with either an intracoronary stent, laser balloon or perfusion balloon. Group II patients had fewer Q-wave myocardial infarctions (9.1 vs 20.3%, p = 0.005). In addition, peak creatine phosphokinase levels (826 ± 1,515 vs 517 ± 1,050, p < 0.01) and mean residual stenosis (40.7 ± 33.2 vs 58.0 ± 34.4%, p < 0.0001) were also lower in group II patients. There was also toss coronary artery bypass grafting during the same admission (38.6 vs 29.5%, p = 0.02) in group II patients. These data suggest that there has been a recent improvement in the clinical outcome of patients with acute closure. This improvement may be related to a more aggressive use of prolonged inflation with standard balloons, in addition to the use of intracoronary stents, laser balloons and perfusion balloons.