To assess the likelihood of procedural success in patients with multivessel coronary disease undergoing percutaneous coronary angioplasty, 350 for type C stenoses, a 61% success and a 21% complication rate. The subdivision into types Bi and B2 provided significantly more information in this clinically importantintermediate risk group than did the standard ACC/AHA scheme. The stenosis characteristics of chronic total occlusion, highgrade (80-99% diameter) stenosis, stenosis bend of more than 60°, and excessive tortuosity were particularly predictive of adverse procedural outcome. This improved scheme may improve clinical decision making and provide a framework on which to base meaningful subgroup analysis in randomized trials assessing the efficacy of percutaneous coronary angioplasty. (Circulation 1990;82:1193-1202 T he clinical and anatomic heterogeneity of short-and long-term outcomes with percutaneous patients with multivessel coronary artery discoronary angioplasty (PTCA). Previous short-term ease might expectedly lead to differences in follow-up studies have focused on the feasibility andFrom the Divisions

Among moderate- to high-risk patients with ACS undergoing PCI, coronary flow reserve was greater with bivalirudin than eptifibatide. Eptifibatide improved myocardial perfusion and reduced the duration of post-PCI ischemia but was associated with higher minor bleeding and transfusion rates. Ischemic events and biomarkers for myonecrosis, inflammation, and thrombin generation did not differ between agents.

Mild stenoses in coronary arteries > or = 1.5 mm in diameter serving modest amounts of myocardium do not appear to need to be revascularized to achieve good long-term outcome with coronary angioplasty. Hence, angioplasty in such lesions may not be justified except when they are documented to cause life-style-limiting angina, and the standard definition of complete revascularization by angioplasty appears to be suboptimal. The importance of optimally defined adequate revascularization should be considered in the interpretation of the results of randomized trials assessing the clinical efficacy of coronary angioplasty compared with that of other modalities of therapy.

Recognition of risk factors for poor long-term outcome in this setting may improve clinical decision making and provide a framework on which to base meaningful subgroup analyses in randomized trials assessing the efficacy of coronary angioplasty.