| Effect of transient abrupt vessel closure during otherwise successful angioplasty for unstable angina on clinical outcome at six months. Hirulog Angioplasty Study Investigators. | |
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MedLine Citation:
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PMID: 9935011 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The objective of this study was to identify predictors of major adverse cardiac events after successful coronary angioplasty. BACKGROUND: The acute complications of angioplasty are related to baseline clinical and angiographic variables, and early complications adversely affect long-term outcome. However, the predictors of enduring success after uncomplicated angioplasty are less well defined. METHODS: Of 4,098 patients undergoing angioplasty in the Hirulog Angioplasty Study, 3,899 (95%) had a successful procedure without in-hospital death, emergent bypass surgery or clinical evidence of myocardial infarction. Baseline and procedural variables for these 3,899 patients were examined. RESULTS: Major adverse cardiac events occurred in 22% of the patients with initially successful procedures at 6 months: death in 1%, myocardial infarction in 2% and repeat revascularization in 21%. Univariable predictors of increased events included successful salvage from abrupt vessel closure (p < 0.001), emergency stenting (p < 0.001), multilesion angioplasty (p < 0.001), diabetes (p=0.02), target lesion in the left anterior descending artery (p=0.02), unstable angina (p=0.03) and smaller final luminal diameter (p=0.04). There was a trend toward increased events among patients with prior angioplasty (p=0.08), but asymptomatic elevation of the creatine kinase was not predictive (p=0.5). In a multivariable model, abrupt vessel closure was the strongest independent predictor of major adverse cardiac events at 6 months (p < 0.001; odds ratio [95% confidence interval]=3.6 [2.5 to 5.1]), while multivessel angioplasty, target lesion in the left anterior descending artery and diabetes also remained independent predictors (all p < or = 0.02). CONCLUSIONS: This analysis suggests that "uncomplicated" abrupt vessel closure is a powerful predictor of adverse clinical outcome following successful angioplasty. Improved techniques to reduce abrupt closure during angioplasty are thus urgently needed, and patients who experience "uncomplicated" closure require closer surveillance during follow-up. |
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Authors:
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R N Piana; W H Ahmed; B Chaitman; P Ganz; S Kinlay; J Strony; B Adelman; J A Bittl |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 33 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1999 Jan |
Date Detail:
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Created Date: 1999-02-17 Completed Date: 1999-02-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 73-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. RNPiana@BICS.BWH.Harvard.Edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angina, Unstable / diagnosis, mortality, therapy* Angioplasty, Transluminal, Percutaneous Coronary* Anticoagulants / administration & dosage Double-Blind Method Female Follow-Up Studies Heparin / administration & dosage Hirudins / administration & dosage, analogs & derivatives Hospital Mortality Humans Male Middle Aged Myocardial Infarction / diagnosis, mortality, therapy Peptide Fragments / administration & dosage Recombinant Proteins / administration & dosage Recurrence Stents Survival Rate |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 1999 Jan;33(1):79-81
[PMID:
9935012
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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