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The availability of circulatory support devices has increased the importance of accurately identifying patients at risk for hemodynamic compromise during percutaneous transluminal coronary angioplasty (PTCA). Accordingly, prospective evaluation of 3 criteria to predict hemodynamic compromise (defined as a decrease in systolic blood pressure [greater than or equal to]20 to The scoring system was then prospectively applied to 61 consecutive patients (group B) undergoing PTCA. In using a risk score [greater than or equal to]4 to define high risk, this scoring system had a sensitivity of 92% and a specificity of 92%. In the same population, ejection fraction 50% of myocardium at risk had a 13% sensitivity. Therefore, it is concluded that this scoring system substantially improves the ability to predict hemodynamic compromise during PTCA with a high sensitivity and specificity. (Am J Cardiol 1992;70:1540-1545)

Since its initial performance, balloon percutaneous transluminal coronary angioplasty (PTCA) has been limited by a small but finite incidence of acute coronary dissection. This can result in abrupt vessel closure, usually managed with urgent coronary artery bypass grafting. Despite improvements in equipment, technique, and operator experience, the need for urgent bypass after PTCA has remained relatively stable at 2% to 5%, due in part to the expanding indications of the procedure and its use in patients with more complicated conditions and lesions.[1] Techniques that have been used to stabilize acute coronary dissections and avoid emergency coronary bypass surgery include repeat PTCA balloon inflations, prolonged balloon inflations with perfusion balloons,[2,3] laser balloons,[4] and permanent and temporary stenting.[5,6] The recent availability of directional coronary atherectomy (DCA) has made possible an additional technique for the acute treatment of coronary dissection.[7] The purpose of this report is to assess both the acute and long-term efficacy of directional coronary atherectomy for the treatment of failed PTCA due to refractory abrupt closure.

Patients with a significant residual stenosis after thrombolytic therapy are believed by many to be at increased risk for repeat ischemic events and may be candidates for prompt angiography and revascularization. To test the hypothesis that patients with antecedent angina (Canadian classes I to IV, ⪢-24 h before myocardial infarction) are more likely to have a significant residual stenosis ≥60% diameter reduction) than are those without antecedent angina, the coronary angiograms of 82 consecutive patients undergoing routine angiography after thrombolytic therapy were reviewed. Compared with the patients without antecedent angina, the group with antecedent angina had an increased mean stenosis (74% versus 58%) and more multivessel disease (44% versus 5%).