Does the AHA/ACC task force grading system predict outcome in multivessel coronary angioplasty?

To assess the ACC/AHA task force grading system as a predictor of outcome in patients undergoing multivessel percutaneous transluminal coronary angioplasty we analyzed all failures (residual stenosis >50%, Q-wave myocardial infarction, coronary artery bypass grafting during hospitalization, or death) in 97 patients with 328 stenoses. There were 70 males and 27 females; 60 patients had stable angina, and 37 had unstable angina. The mean number of lesions dilated per patient was 3.4 (range 2-8). The mean preangioplasty percent luminal diameter narrowing was 80 ± 14%. Thirty-eight stenoses were AHA/ACC classification type A, 192 type B, and 98 type C. One hundred twenty-eight lesions were located in the left anterior descending artery or its distribution, 89 in the left circumflex, 96 in the right coronary artery, and 15 in other vessels. Procedural success ( 3 months, followed by total occlusion 90°) segment. No clinical variables (age, sex, angina type, previous PTCA, or previous thrombolytic therapy) were predictive of adverse outcome. Thus, the standard ACC/AHA grading system does predict lesions at increased risk of adverse outcome in multivessel percutaneous coronary angioplasty; however, the use of only a few criteria open to less subjective interpretation would be simpler and more relevant to clinical use.