Evaluation of the Society for Coronary Angiography and Interventions' lesion classification system in 14,133 patients with percutaneous coronary interventions in the current stent era.

We recently showed that the ACC/AHA coronary lesion classification could be simplified with no loss of predictive value (SCAI I = patent/non-C; SCAI II = patent/C; SCAI III = occluded/non-C; SCAI IV = occluded/C). We now test this system in a database reflecting current stent usage. Data from 14,133 patients with single-native-vessel interventions recorded in the Society for Coronary Angiography and Interventions (SCAI) Registry from July 1996 to July 1999 were analyzed. Stents were used in 60.2% of procedures. Logistic models predicting angiographic success suggested a slight, clinically insignificant preference for the SCAI classification (c-statistic = 0.692 vs. 0.670). Models using clinical variables to predict major complications were superior to models using only lesion classification. Lesion characteristics were related to outcomes primarily in elective (not acute myocardial infarction) patients. In the current PCI device era, the simpler SCAI classification using 7 variables predicted interventional success and complications as well as or better than the ACC/AHA system requiring 26.

Left main crumpling during left anterior descending angioplasty: hitherto unreported location for the "accordion effect".

Vessel wall shortening and deformity due to "arterial telescoping" is a not infrequent reversible phenomenon that occurs during coronary angioplasty and is associated with the advancement of a stiff wire through elongated and tortuous segments, with straightening of the artery and deep guiding catheter introduction beyond the coronary ostium. We present the first described case of the accordion effect involving the left main coronary artery. On detecting arterial crumpling, it is essential to make a differential diagnosis between the accordion syndrome and PTCA potential complications (spasm, thrombosis and dissection), to avoid further therapeutic intervention.

A simplified lesion classification for predicting success and complications of coronary angioplasty. Registry Committee of the Society for Cardiac Angiography and Intervention.

In 1988, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures presented a classification of coronary lesions utilizing 26 lesion features to predict the success and complications of balloon angioplasty. Using data from the Registry of the Society for Cardiac Angiography and Interventions (SCAI) we evaluated the ability of this classification to predict success and complications. Lesion success, death in hospital, emergency cardiac bypass surgery, and major adverse events were evaluated in 41,071 patients who underwent single-vessel angioplasty from January 1993 to June 1996. Logistic models using the ACC/AHA lesion classification, vessel patency, or both, were compared. A new classification based on the interaction of the ACC/AHA classification plus lesion patency was compared with the existing ACC/AHA classification. Vessel patency, added to the ACC/AHA classification, improved prediction of lesion success (p

The California experience with the diversion program for impaired physicians.

Since January 1980, following a change in California law, impaired physicians have been given the opportunity to be diverted from possible medical board discipline into a statewide treatment program financed by the Board of Medical Quality Assurance. The success of the program has depended on a rapid response mechanism, an individualized treatment program, an ironclad confidentiality, and a multilevel monitoring system. This nondisciplinary approach has made it easier for physicians to encourage their sick colleagues to volunteer for treatment. The experience after 2 1/2 years indicates that impaired physicians are found and treated more quickly when legal restrictions against the physicians' licenses are avoided. Of the 117 physicians currently participating in the California Diversion Program, 109 have been able to continue their practice of medicine while undergoing treatment.

[Endometritis and abortion by association of Lippes' loop and pregnancy with intraplacental insertion of the apparatus]. / Endométrie et avortement par association de boucle de Lippes et grossesse avec insertion intra-placentaire de l'appareil.

PIP: A case of spontaneous abortion of a 3 1/2 month gestation, 6 months after insertion of a Lippes loop is described briefly. The 34-year old multipara had experienced bleeding, diagnosed by X-ray as malposition of the IUD. Histologic examination of the placenta revealed necrotic lesions infiltrated with fibrin and polymorphonuclear leucocytes, alternating with intact, often double-layered chorion and glands also infiltrated with polymorphonuclear leucocytes.^ieng