Risk factors for the development of post-lab acute coronary occlusion following successful percutaneous transluminal angioplasty.

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Acute coronary occlusion can occur following percutaneous transluminal coronary angioplasty (PTCA) upon return to the coronary care unit (CCU), and is sometimes life-threatening. To identify high-risk patients for acute occlusion following PTCA, we analyzed 11 patients with post-lab acute occlusion. All of the patients had some evidence of intimal tear or dissection at the site of dilatation. During the study period, 1343 patients (1998 lesions) with angina pectoris underwent PTCA. Of these, 331 vessels (17%) had some degree of intimal tear or dissection at the site of dilatation. From these 331, 50 patients (50 vessels) without evidence of acute occlusion were randomly selected to serve as the control group. Patients in the acute occlusion group had more extensive dissection (p<0.05) and less water balance (drip-infused water-urine, ml) during angioplasty (p<0.1) than those in the control group. Furthermore, a significantly higher percentage of patients in the acute occlusion group complained of chest discomfort upon arrival at the CCU (72% vs 8%, p<0.0001). These variables may be useful in identifying high-risk patients for post-lab acute occlusion, particularly in the presence of an intimal tear or dissection at the target site.
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