PCI complications: factors associated with complications

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Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

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PCI Complications

Factors Associated with Complications
Vessel Perforation
Dissection
Distal Embolization
No-reflow
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Restenosis
Renal Failure
Thrombocytopenia
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

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Risk calculators and risk factors for PCI complications: factors associated with complications

Editors-In-Chief: Alexandra Almonacid M.D. [1]; Jeffrey J. Popma M.D. [2]

Early Clinical Outcomes After PCI

  • Anatomic Success: Residual diameter stenosis < 50 % which is generally associated with at least a 20 percent improvement in diameter stenosis and relief of ischemia.
  • Pre-Stent Era: 72 – 74%.
  • Stent Era: 82 – 98%
  • Procedural Success: Angiographic success without the occurrence of major complications (death, MI, or CABG) within 30 days of the procedure.
  • Clinical Success: Procedural success without the need for urgent repeat PCI or surgical revascularization within the first 30 days of the procedure

Variables Associated with Early Failure and Complications After PCI

  • Clinical variables
    • Women
    • Advanced Age
    • Diabetes Mellitus
    • Unstable or Canadian Cardiovascular Society (CCS) Class IV angina
    • Congestive heart failure
    • Cardiogenic shock
    • Renal insufficiency
    • Preprocedural instability requiring intraaortic balloon pump support
    • Preprocedural Elevation of C-reactive protein
    • Multivessel Coronary Artery Disease
  • Anatomic variables
    • Multivessel CAD
    • Left Main Disease
    • Thrombus
    • SVG intervention
    • ACC/AHA Type B2 and C lesion morphology
    • Chronic total coronary occlusion
  • Procedural factors
    • A higher final percent diameter stenosis
    • Smaller minimal lumen diameter
    • Presence of a residual dissection or trans-stenotic pressure gradient

Risk Scores

Mayo Clinic Risk Score

Mayo Clinic Risk Score.Multivariate Predictors of Procedural Complication After PCI -3,264 pts undergoing PCI- Dynamic Registry at the National Heart, Lung, and Blood Institute. Adapted from Singh et al. J Am Coll Cardiol 2003; 42:1722-8

CADILLAC Risk Score

The Cadillac Risk Score: Integer Scoring System. From Halkin et al. J Am Coll Cardiol 2005; 45(9):1397-1405

References

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