Angioplasty of complex lesions in XXXX : results of the Thrombolysis and Angioplasty in @entity1459 (TAUSA) trial.

@entity1 @entity63 @entity75 @entity1066 @entity1459 @entity951 @entity1188 @entity715
OBJECTIVES: This study sought to analyze the role of complex lesion morphology on the acute results of angioplasty. BACKGROUND: Acute complications of angioplasty are higher in unstable than in stable @entity951 . The unstable culprit lesion is usually complex, indicative of plaque disruption and @entity715 formation. Previous nonrandomized studies have shown that the presence of intracoronary thombus increases morbidity after coronary angioplasty. The role of complex morphology in coronary angioplasty outcome was studied in a prespecified subgroup analysis of a large multicenter coronary angioplasty trial. METHODS: The results of coronary angioplasty from the Thrombolysis and Angioplasty in @entity1459 (TAUSA) trial were analyzed. This large trial randomized 469 @entity1 in double-blinded manner to receive either intracoronary urokinase or placebo during coronary angioplasty of the culprit lesion in @entity63 with or without recent @entity1188 . The study presented here analyzes in detail the results of coronary angioplasty in complex versus simple lesions in the urokinase and placebo groups. @entity75 were defined before angioplasty by a core laboratory as having one or more of the following: irregular borders, overhanging edges, @entity1066 or intraluminal filling defects proximal or distal to the lesion. RESULTS: Of the 469 @entity1 , 458 had identifiable culprit lesions, of which 245 were complex and 213 were simple. @entity75 were associated with a higher abrupt closure rate than simple lesions (10.6% vs. 3.3%, respectively, p < 0.003). @entity1 with complex lesions also had higher recurrent in-hospital @entity951 (p < 0.02) and emergent bypass surgery (p < 0.02). Further analysis of complex lesions revealed that abrupt closure was particularly high in the urokinase group (15.0% vs 5.9% for the placebo group, p < 0.03), and most abrupt closures were @entity715 . Composite clinical end points were also significantly higher with complex lesions and urokinase. In the placebo group, complex lesions had a higher abrupt closure rate as well as postcoronary angioplasty filling defects, but clinical end points were not significantly different. CONCLUSIONS: @entity75 before coronary angioplasty increase acute complication rates after coronary angioplasty. Urokinase as administered in the TAUSA trial had significant adverse effects, especially in complex lesions. However, even in the placebo arm, complex lesions were associated with higher complication rates than simple lesions. Newer antithrombotic measures that particularly target the platelet may eventually decrease complication rates in these lesions.
