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Risk Factors and Outcomes

Edward L. Hannan, PhD; Djavad T. Arani, MD; Lewis W. Johnson, MD; Harvey G. Kemp, Jr, MD; Gary Lukacik, MA

JAMA. 1992;268(21):3092-3097.

Abstract
Objective.
—To identify significant independent risk factors for major percutaneous transluminal coronary angioplasty outcomes.

Design.
—Retrospective analysis using univariate and logistic regression analysis to identify significant independent risk factors for adverse outcomes.

Setting.
—All 31 hospitals performing percutaneous transluminal coronary angioplasty in New York State in 1991.

Patients.
—All 5827 patients undergoing percutaneous transluminal coronary angioplasty between January 1, 1991, and June 30, 1991, in New York State.

Main Outcome Measures.
—In-hospital mortality, major complication(s) (in-hospital mortality, myocardial infarction, and/or emergency coronary artery bypass graft), and absence of angiographic success (stenosis reduction of less than 20% on any attempted lesion or residual stenosis of at least 50% on any attempted lesion).

Main Results.
—Before discharge from the hospital, a total of 37 patients (0.63%) died; 67 patients (1.1%) suffered a myocardial infarction, with a mortality rate of 4.5%; and 97 patients (1.7%) underwent emergency coronary artery bypass graft surgery, with a mortality rate of 2.1% (no deaths in 85 patients who were hemodynamically stable and two deaths among 12 patients who were hemodynamically unstable). A total of 187 patients (3.2%) experienced a major complication. Angiographic success was achieved for 88% of all patients. Multivariate analysis found four independent preprocedural variables related to death: female gender, hemodynamic instability, shock, and ejection fraction.

Conclusions.
—Percutaneous transluminal coronary angioplasty outcomes in New York compare favorably with other recent results reported in the literature. Several preprocedural variables markedly increase the incidence of adverse events.

(JAMA. 1992;268:3092-3097)

Author Affiliations
From the Departments of Health Policy and Management and Biostatistics, State University of New York at Albany (Dr Hannan); the New York State Department of Health, Albany (Dr Hannan and Mr Lukacik); the Department of Medicine, State University of New York at Buffalo and the Buffalo General Hospital (Dr Arani); the Department of Medicine, State University of New York Health Science Center at Syracuse and the Cardiovascular Laboratory, St Joseph's Hospital, Syracuse (Dr Johnson); and St Luke's/Roosevelt Hospital Center and the Department of Clinical Medicine, Columbia University College of Physicians and Surgeons, New York, NY (Dr Kemp).

Footnotes
Reprint requests to New York State Department of Health, 2019 Corning Tower Bldg, Albany, NY 12237 (Dr Hannan).

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