Acute complications of percutaneous transluminal coronary angioplasty for total occlusion

The incidence of major complications after percutaneous coronary angioplasty (PTCA) of a totally occluded artery was assessed retrospectively. A total of 1649 PTCA procedures were analyzed. After exclusion of procedures for acute myocardial infarction or total occlusion that resulted from restenosis, 90 patients were selected. Forty-four patients (49%) had stable angina and 46 (51%) had unstable angina. The estimated duration of occlusion was 87 ± 78 days in patients with stable angina, as compared with 10 ± 8 days in patients with unstable angina (p < 0.001). Abrupt vessel closure during PTCA occurred only in patients with unstable angina (0% versus 17%, p < 0.05). The major complication rate was 2.5% in the stable angina group, and 20% in unstable angina group (p < 0.01). This rate was also significantly higher than the complication rate of 8% observed in 442 procedures that were performed during the same period in patients with the unstable angina and nonocclusive stenosis (p < 0.01). Patients with unstable angina who undergo PTCA of a totally occluded artery represent a subset at high risk for major complications.