Usefulness of quantitative and qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events during and after native coronary balloon angioplasty

Major, adverse cardiac events (death, myocardial infarction, bypass surgery and reintervention) occur in 4 to 7% of all patients undergoing coronary balloon angioplasty. Prospectively collected clinical data, and angiographic quantitative and qualitative lesion morphologic assessment and procedural factors were examined to determine whether the occurrence of these events could be predicted. Of 1,442 patients undergoing balloon angioplasty for native primary coronary disease in 2 European multicenter trials, 69 had major, adverse cardiac procedural or in-hospital complications after ≥1 balloon inflation and were randomly matched with patients who completed an uncomplicated in-hospital course after successful angioplasty. No quantitative angiographic variable was associated with major adverse cardiac events in univariate and multivariate analyses. Univariate analysis showed that major adverse cardiac events were associated with the following preprocedural variables: (1) unstable angina (odds ratio [OR] 3.11; p 45 ° (OR 2.34; p 45 ° (OR 2.87; p 45 ° (OR 2.54; p < 0.006) were independent predictors of major adverse cardiac events

Functional assessment of intracoronary Doppler: the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) study: preliminary results

Introduction The limitations of angiography have prompted inves­ tigators to use alternative methods for the functional assessment of angioplasty results. Various digital angiographic techniques and Doppler catheters were introduced and tested. However, only with the introduction of a Doppler angioplasty guide wire has the continuous measurement of blood flow velocity during a routine angioplasty procedure become possible. The main advantage of this system is the possibility of positioning the guide wire distal to the stenosis and reliably assessing the flow impairment induced by the stenosis under treatment. The veloc­ ity measurements can be repeated after angioplasty leaving the guide wire in place, distal to the steno­sis, during dilatation. A normalization of flow veloc­ ity parameters after successful angioplasty will indicate that an adequate lumen enlargement has been achieved and a normal vascular conductance restored. The results of small-sized single-center studies have shown an improvement of the flow velocity indices in most cases after percutaneous transluminal coronary angioplasty (PTCA). Up to now, however, no appropriately sized prospective studies have assessed the value of flow velocity indices in predicting immediate complications and recurrence of symptoms after PTCA