CLINICAL AND ANGIOGRAPHIC DETERMINANTS OF PRIMARY CORONARY ANGIOPLASTY SUCCESS

Clinical and anatomic determinants of the initial success of percutaneous transluminal coronary angioplasty were prospectively evaluated in 826 patients enrolled in the Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART). The 639 men and 187 women ranged in age from 31 to 85 years. Successful angioplasty (residual stenosis < 50% and no major complications) was achieved in 886 (88.6%) of 1,000 lesions. Success rates were uniform among the eight individual centers. Outcome was not influenced by gender, age or other clinical features, including severity and duration of angina, prior myocardial infarction, rest pain, transient ST segment elevation, history of smoking or diabetes. In contrast, procedural outcome was significantly associated with lesion-specific angiographic factors. Stenoses 60% to 74%, 75% to 89%, 90% to 99% and 100% were associated with success rates of 96%, 90%, 84% and 69%, respectively (p < 0.001). Angioplasty was less successful in calcified than in noncalcified lesions (82% versus 90%, p < 0.01), in thrombotic than in nonthrombotic lesions (82% versus 90%, p < 0.05) and in lesions in the right coronary artery than in other vessels (84% versus 90%, p < 0.01). Outcome was not related to other anatomic variables, including lesion location (proximal versus distal), vessel size, eccentricity, stenosis length or translesional gradient. By multivariate logistic regression, preangioplasty percent stenosis, right coronary artery location and lesion calcification were demonstrated to be significant independent predictors of angioplasty success. Alternative clinical and angiographic variables did not contribute to this regression model. These results suggest that attempted coronary angioplasty is no longer adversely influenced by previously important clinical features (female gender) or anatomic factors (circumflex artery or distal locations or ecentric morphology). Although patient-related variables had no predictive value, primary angioplasty success was significantly affected by specific angiographic factors. Stenosis severity, calcification, thrombus and right coronary artery location were the principal determinants of coronary angioplasty outcome.