**7. Conclusion**

42 Coronary Interventions

**Risk Factor EuroSCORE STS Score CANADA Score** 

Preoperative use of iv

LVEF 30–50%; LVEF

Systolic PA pressure >30

Procedure status is emergent or salvage. *Emergent:* The patient's clinical status includes any of the following. a. Ischaemic dysfunction (any of the following): (1) ongoing ischaemia including rest angina despite maximal medical therapy (medical and/or IABP); (2) acute evolving myocardial infarction within 24 h before surgery; or (3) pulmonary oedema requiring intubation. b. Mechanical dysfunction

nitrates

<30%

mmHg

instability prior to the procedure (transient hypotension not fulfilling the definition for cardiogenic shock, or caused by sustained

arrhythmia) or the anticipated need for an intra-aortic balloon pump.

STEMI on-going, STEMI recurrent or

other ACS

LVEF

delay

LVEF 30–50%; LVEF <30% or

contraindicated\*

Procedure has to be done without

failure (anuria or oliguria

Rest angina requiring iv nitrates until arrival in the

50%; Poor or LVEF ,30%

Systolic PA pressure >60

before the beginning of the next working day

< 90 days < 21 days

anaesthetic room

LV dysfunction Moderate or LVEF 30–

mmHg

Emergency Carried out on referral

<10 ml/ h)

Unstable angina

Recent myocardial infarction

Pulmonary hypertension

> Predicting procedural risk enables the correct treatment decisions to be made and allows valid informed consent and accurate patient counselling. This is particularly important as PCI has become accepted as a viable alternative to established surgical intervention. Early assessment of risk with PCI was limited to short term events that ignored important late events and prevented direct comparison with surgical risk predication tools. The CANADA Score was developed to accurately predict 30 day mortality risk and has been externally validated in large North American cohorts demonstrating broad applicability to varied patient groups. The CANADA Score confirms that both anatomical and clinical data are required to provide accurate and discriminatory 30 day mortality risk prediction and it therefore allows comparison with well validated surgical risk prediction models to guide optimal revascularisation strategy. Application of the CANADA Score to patients with high surgical risk demonstrates the potential for equal or greater risk with a percutaneous

Percutaneous Coronary Intervention and 30-Day Mortality: The CANADA Score 45

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Fig. 5. On-line CANADA Score Calculator. Available at www.canadascore.org

#### **8. References**


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Fig. 5. On-line CANADA Score Calculator. Available at www.canadascore.org

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**3** 

Seung-Jin Lee

*South Korea* 

*Soonchunhyang University Cheonan Hospital* 

**Complications of Coronary Intervention** 

Drug-eluting stents (DES) substantially reduce restenosis compared with bare metal stents and represent a significant advance in percutaneous coronary interventions (PCIs). Accordingly, DES have been rapidly adopted into practice and are currently used in the vast majority of PCI procedures. As PCIs for more complicated lesions increase, various complications, such as stent thrombosis, fracture, dissection or perforation, are also increase. For example, PCIs for patients who have chronic total occlusion increase and these patients tend to have more risk factors like diabetes mellitus, hypertension, dyslipidemia, and previous myocardial infarction and also have multi-vessel diseases and have decreased left ventricular ejection fraction. If major procedure-related complications were developed in these high risk patients, it may leads to fatal results. So it is important to understand

possible complications of PCIs and eliminate potential risk factors before procedures.

Drug-eluting stents (DES) have proven very effective in reducing restenosis by suppressing neointimal hyperplasia. However, potentially serious complications such as in-stent restenosis and thrombus still occur. Stent fracture has been identified as a possible contributor to these adverse outcomes. A number of risk factors for the development of stent fracture have been described, although a detailed analysis of the angiographic factors

Stent fracture is defined as the cases where the linear or curvilinear connections of stent struts are interrupted and areas of the stented segment are uncovered by stent struts visible on coronary angiography. The incidence of stent fracture is reported in 0.8-7.7% of cases.1-8 However, because of limited sensitivity of angiography to detect fracture, its true incidence is still unknown. In a recent report analyzed from autopsy findings, stent fracture was observed in 29% of total patients.9 So, the real incidence of stent fracture is assumed to be a little higher than what has been clinically reported. Stent fracture from patients treated with Cypher stents is more frequently observed than in cases of Taxus stents. The incidence of stent fracture of Cypher stent was 1.3% in the SIRIUS trial,9 compared to 0.58% incidence with the Taxus stent is in the Taxus IV/V/VI trials. Stent fracture has previously been recognized in noncoronary vessels, especially in the superficial femoral and popliteal arteries

**1. Introduction** 

**1.1 Stent fracture** 

predisposing to stent fracture is lacking.

**1.2 Incidence and definition** 

mortality and morbidity risk models. *Ann Thorac Surg.* 2003;75(6):1856-1864; discussion 1864-1855.

