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Periprocedural complications of percutaneous coronary intervention

Authors
Joseph P Carrozza, MD
Thomas Levin, MD
Section Editor
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Complications seen during percutaneous coronary intervention (PCI) include those related to cardiac catheterization and diagnostic coronary angiography, and those that occur as a consequence of the specific equipment (eg, wires) required for the intervention or the intervention itself (eg, distal embolization leading to myocardial ischemia). The periprocedural complications related to PCI will be reviewed here. The complications of cardiac catheterization are discussed separately. (See "Complications of diagnostic cardiac catheterization".)

Improvements in devices, the use of stents, and aggressive antiplatelet therapy have significantly reduced the incidence of major periprocedural complications of PCI over the past 15 to 20 years. As an example, the need for emergent coronary bypass surgery (CABG) decreased in two series from 1.5 percent in 1992 to 0.14 percent in 2000 [1], and from 2.9 percent in 1979 to 1994 to 0.3 percent in 2000 to 2003 [2]. (See 'Emergency CABG for failed PCI' below.)

In this discussion, PCI refers to any therapeutic procedure during which a wire or catheter is inserted into a coronary artery. Balloon angioplasty without stenting will be referred to as percutaneous transluminal coronary angioplasty (PTCA). When clinically important data specific to PTCA are available, it will be given. The term PCI will be used when studies include patients who have had either PTCA or stenting. Studies of stenting alone will be presented as such.

The widespread use of intracoronary stents rather than balloon angioplasty alone has resulted in the periprocedural complications of PTCA been being largely replaced by complications seen with stenting.

INCIDENCE AND CAUSES OF EARLY MORTALITY

The widespread use of stents (compared to balloon angioplasty) and improvements with time in stent design and technique have led to a decreasing risk of major acute complications and no increase in mortality rates despite the increasing complexity of cases [3,4]. A report from the American College of Cardiology National Cardiovascular Data registry included over 100,000 percutaneous coronary intervention (PCI) procedures (stent placement in 77 percent) performed between 1998 and 2000 [4]. The incidences of in-hospital Q wave myocardial infarction, urgent coronary artery bypass graft surgery (CABG), or death were 0.4, 1.9, and 1.4 percent, respectively. These values may represent an overestimate of current experience, as most laboratories report emergency CABG rates below 0.5 percent [1,5].

                                            

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