Abrupt closure: The CAVEAT I experience

David Holmes, John B. Simpson, Lisa G. Berdan, Ronald S. Gottlieb, Ferdinand Leya, Gordon P. Keeler, Robert M. Califf, Eric J. Topol

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives.: This study sought to assess the incidence and consequences of abrupt closure in a series of patients undergoing directional coronary atherectomy versus percutaneous coronary angioplasty. Background.: Abrupt closure with coronary angioplasty has been associated with adverse outcome. The results from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) I, a randomized trial of coronary angioplasty versus directional coronary atherectomy, were analyzed. Method.: This multicenter trial enrolled 1,012 patients from 1991 to 1992. All records from patients with abrupt closure, which was coded as a discrete complication, were reviewed. Results.: Abrupt closure occurred in 60 patients (5.9%) and was associated with a significantly longer hospital stay (median 8 vs. 3 days). Severe proximal target vessel tortuosity was more common in patients with abrupt closure (20.3% vs. 11.6%, p = 0.046), as was preexistent coronary artery thrombus (30.5% vs. 18.3%, p = 0.02). Abrupt closure was associated with a marked increase in subsequent complications (myocardial infarction 46.7% vs. 2.1%, emergency bypass surgery 383% vs. 0.32%, death 33% vs. 0%) and occurred more frequently in the directional coronary atherectomy group (8.0% vs. 3.8%, p = 0.005). In the coronary angioplasty group, the occlusion usually occurred at the target lesion (91%), presumably related to the effects of barotrauma. In the directional coronary atherectomy group, the site of the occlusion was the target lesion in only 58% (p = 0.045). The remaining occlusions related to problems with the technique (guide catheter or nose cone trauma), reflecting the fact that directional coronary atherectomy is a more complex procedure. Conclusions.: Abrupt closure remains the principal determinant of adverse outcome after percutaneous procedures for the treatment of coronary artery disease. Although abrupt closure is more common with directional atherectomy than angioplasty, the sequelae are similar.

Original languageEnglish (US)
Pages (from-to)1494-1500
Number of pages7
JournalJournal of the American College of Cardiology
Volume26
Issue number6
DOIs
StatePublished - Nov 15 1995

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Atherectomy
Coronary Atherectomy
Angioplasty
Barotrauma
Nose
Multicenter Studies
Coronary Artery Disease
Length of Stay
Coronary Vessels
Emergencies
Thrombosis
Catheters
Myocardial Infarction
Incidence
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Holmes, D., Simpson, J. B., Berdan, L. G., Gottlieb, R. S., Leya, F., Keeler, G. P., ... Topol, E. J. (1995). Abrupt closure: The CAVEAT I experience. Journal of the American College of Cardiology, 26(6), 1494-1500. https://doi.org/10.1016/0735-1097(95)00339-8

Abrupt closure : The CAVEAT I experience. / Holmes, David; Simpson, John B.; Berdan, Lisa G.; Gottlieb, Ronald S.; Leya, Ferdinand; Keeler, Gordon P.; Califf, Robert M.; Topol, Eric J.

In: Journal of the American College of Cardiology, Vol. 26, No. 6, 15.11.1995, p. 1494-1500.

Research output: Contribution to journalArticle

Holmes, D, Simpson, JB, Berdan, LG, Gottlieb, RS, Leya, F, Keeler, GP, Califf, RM & Topol, EJ 1995, 'Abrupt closure: The CAVEAT I experience', Journal of the American College of Cardiology, vol. 26, no. 6, pp. 1494-1500. https://doi.org/10.1016/0735-1097(95)00339-8
Holmes D, Simpson JB, Berdan LG, Gottlieb RS, Leya F, Keeler GP et al. Abrupt closure: The CAVEAT I experience. Journal of the American College of Cardiology. 1995 Nov 15;26(6):1494-1500. https://doi.org/10.1016/0735-1097(95)00339-8
Holmes, David ; Simpson, John B. ; Berdan, Lisa G. ; Gottlieb, Ronald S. ; Leya, Ferdinand ; Keeler, Gordon P. ; Califf, Robert M. ; Topol, Eric J. / Abrupt closure : The CAVEAT I experience. In: Journal of the American College of Cardiology. 1995 ; Vol. 26, No. 6. pp. 1494-1500.
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abstract = "Objectives.: This study sought to assess the incidence and consequences of abrupt closure in a series of patients undergoing directional coronary atherectomy versus percutaneous coronary angioplasty. Background.: Abrupt closure with coronary angioplasty has been associated with adverse outcome. The results from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) I, a randomized trial of coronary angioplasty versus directional coronary atherectomy, were analyzed. Method.: This multicenter trial enrolled 1,012 patients from 1991 to 1992. All records from patients with abrupt closure, which was coded as a discrete complication, were reviewed. Results.: Abrupt closure occurred in 60 patients (5.9{\%}) and was associated with a significantly longer hospital stay (median 8 vs. 3 days). Severe proximal target vessel tortuosity was more common in patients with abrupt closure (20.3{\%} vs. 11.6{\%}, p = 0.046), as was preexistent coronary artery thrombus (30.5{\%} vs. 18.3{\%}, p = 0.02). Abrupt closure was associated with a marked increase in subsequent complications (myocardial infarction 46.7{\%} vs. 2.1{\%}, emergency bypass surgery 383{\%} vs. 0.32{\%}, death 33{\%} vs. 0{\%}) and occurred more frequently in the directional coronary atherectomy group (8.0{\%} vs. 3.8{\%}, p = 0.005). In the coronary angioplasty group, the occlusion usually occurred at the target lesion (91{\%}), presumably related to the effects of barotrauma. In the directional coronary atherectomy group, the site of the occlusion was the target lesion in only 58{\%} (p = 0.045). The remaining occlusions related to problems with the technique (guide catheter or nose cone trauma), reflecting the fact that directional coronary atherectomy is a more complex procedure. Conclusions.: Abrupt closure remains the principal determinant of adverse outcome after percutaneous procedures for the treatment of coronary artery disease. Although abrupt closure is more common with directional atherectomy than angioplasty, the sequelae are similar.",
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