Failed percutaneous coronary intervention: A decade of experience in 21,000 patients

OBJECTIVES: The purpose of this study was to evaluate the incidence, mechanisms, and in-hospital outcomes after failed percutaneous coronary intervention (PCI). BACKGROUND: The most common causes of PCI failure are severe dissection, no-reflow, and uncrossable total occlusions. METHODS: Demographic, clinical, procedural, and quality assurance data were recorded in a prospective database to determine the incidence and outcome of failed PCI. Data were analyzed according to the year of PCI: prestent era (PSE 1993-1995), first generation stent era (FGSE 1996-2000), and contemporary stent era (CSE 2000-2003). RESULTS: PCI (20,884) were performed over a 10-year-period from 1993 through 2003, including 4,344 (20.8%) in the PSE, 9,114 (43.6%) in the FGSE, and 7,426 (35.6%) in the CSE; 19,171 (91.8%) were successful and 1,704 (8.2%) were failures. Nearly 90% of PCI failures are due to no-reflow or uncrossable total occlusions. Among PCI failures, 7.5% were treated medically and 0.7% required emergency coronary artery bypass grafting (ECABG). PCI success was independently associated with PCI during CSE (OR 1.86, P < 0.0001). ECABG decreased sixfold from 1.2% in the PSE to 0.2% in the CSE. CONCLUSIONS: Contemporary PCI patients have better procedural outcomes and fewer in-hospital adverse events than patient treated before the availability of stents. However, recanalization of total occlusions and avoiding no-reflow will have the most impact on future PCI success.