Analysis of factors for acute occlusion of coronary artery in percutaneous transluminal coronary angioplasty

Since August 1983, percutaneous transluminal coronary angioplasty (PTCA) had been performed in 107 patients and possible factors for acute coronary occulusion (ACO) were analyzed. Eighty five patients were male and 22 being female. The ages ranged from 36 to 79 years the average 62.0 years. Seventy had angina pectoris and 37 were in the early stage of acute myocardial infarction. Twenty five or more percent of luminal dilatation was obtained in 72%. ACO developed in 18 patients (16%). From the angiographic findings, dissection was found in 4, thrombus formation in 7, and spasm which was relieved by intracoronary nitroglycerin in 4patients. ACO developed within 15 min in all but one who developed ACO 22 hrs later. Differences in age, sex, or the system employed for PTCA was not associated with ACO. A slight but non-significantly higher incidence was found for concentric stenosis, or lesions in the left circumflex artery. Repeated PTCA was done in 12 patients with success in 11 patients. One developed ACO again and required emergency bypass grafting. In the remaining 6 patients, bypass surgery was performed immediately after ACO. Although PTCA is certainly a useful therapeutic tool to manage ischemic heart disease or to salvage jeopardized myocardium it is associated with major complications which require prompt interventions such as emergency bypass grafting