Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

Kinnaird, Tim; Kwok, Chun Shing; Kontopantelis, Evangelos; Ossei-Gerning, Nicholas; Ludman, Peter; deBelder, Mark; Anderson, Richard; Mamas, Mamas A.

doi:10.1161/circinterventions.115.003449

Cited by 107 publications

(77 citation statements)

References 30 publications

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“…In prior studies, various clinical and angiographic factors such as age, female gender, lower BMI, chronic kidney disease, hypertension, left ventricular dysfunction, peripheral arterial disease, cardiogenic shock, use of mechanical circulatory support, previous PCI or CABG, complex (ACC/AHA type C) lesions, coronary dissection, left main PCI, CTOs, calcified lesions, use of atherectomy and intravascular ultrasound have been associated with the occurrence of coronary perforation . Similarly, in our study, complex lesions, previous PCI and low pre‐procedure TIMI flow were independently associated with coronary perforation.…”

Section: Discussionsupporting

confidence: 80%

“…Coronary perforation is an infrequent, but potentially life threatening complication of percutaneous coronary intervention (PCI), with a reported incidence ranging from 0.29% to 0.71% . There are two major types of coronary perforations: large vessel perforation and distal vessel perforation, with collateral vessel perforation being another type specific to chronic total occlusion (CTO) interventions .…”

Section: Introductionmentioning

confidence: 99%

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Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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Objectives We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation. Background Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations. Methods Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk‐adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One‐year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined. Results Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22–13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in‐hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations. Conclusions Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in‐hospital mortality, highlighting the importance of prevention.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Incidence, predictors, management and outcomes of coronary perforations

Shaukat

Tajti

Sandoval

et al. 2018

Cathet Cardio Intervent

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“…A worldwide increase in the complexity of PCI procedures, including development of new techniques and better tools, has resulted in a reduction in the need for emergency surgery to 3-13%. 2,9 In this study it was even more rare: 1.2%. We found a significantly higher incidence of a CAP in CABG patients but reassuringly the risk of treating a saphenous vein graft or arterial graft was not significantly different…”

Section: Study Limitationsmentioning

confidence: 45%

Coronary Artery Perforation and Tamponade　― Incidence, Risk Factors, Predictors and Outcomes From 12 Years’ Data of the SCAAR Registry ―

Harnek

James

Lagerqvist

2019

Circ J

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he incidence of coronary artery perforation (CAP) and/or tamponade in patients undergoing percutaneous coronary interventions (PCI) is proportional to the complexity of the procedure, ranging from 0.2-0.4% in non-complex lesions, 1,2 to 1.4-4.1% in chronic total occlusions (CTO). 3,4 In contemporary registries the 1-year all-cause mortality after CAP is 18-35%, which is 2-3-fold higher than in patients without CAP. 2,5-9 Predictors of CAP have been found to be age, female sex, atherectomy devices, hydrophilic wires, oversized balloons and/or stents, and excessive post dilations, as well as complex procedures such as calcified lesions, previous coronary artery bypass grafting (CABG), and CTO. 2,5,8-10 Perforations based on their angiographic appearance were classified by Ellis et al into tree classes. 11 However, this risk stratification may be insufficient because almost 21-25% of CAP cases are not recognized during the procedure, but afterwards in the ward as tamponade. 2,5 A fatal outcome of CAP directly correlates with development of tamponade and concurrent arrhythmias with a high need for emergency pericardiocentesis. 2,9 There may be differences in the clinical presentation, because a perforation with acute tamponade is likely caused by oversized balloons and a stent in the proximal arteries, whereas distal perforations are likely caused by distal guidewire exits in smaller arteries and many are missed in the catheter laboratory (cath-lab) only to be disclosed as late tamponade in the ward. It is unknown if there are differences in outcomes between acute and late tamponade after a perforation. We report the incidence, risk factors, and short-and long-term (12 years) outcomes of CAP from the perspective of clinical relevance depending on the occurrence of a perforation and whether it was accompanied by acute or late tamponade. Methods Data were collected between 1 May 2005 and 23 January 2017 from the Swedish Coronary Angiography and Angioplasty Register (SCAAR), which is an integrated part of the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART), with at least 1 year of follow-up. Data in the SCAAR are recorded online through a web interface for all consecutive patient data from every center (n=30) performing PCI in

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“…Coronary perforations are infrequent (0.33% of all cases) but are associated with poor short‐ and long‐term outcomes. Kinnaird et al analyzed 527 121 interventions of the British Cardiovascular Intervention Society Database, showing that female sex, older age, rotational atherectomy, and CTO PCI were independent predictors of perforation 49. The incidence of coronary perforations among 26 807 CTO interventions from the same registry was 1.40%.…”

Section: Perforationmentioning

confidence: 99%

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

Tajti

Brilakis

2018

JAHA

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Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

Cited by 107 publications

References 30 publications

Incidence, predictors, management and outcomes of coronary perforations

Incidence, predictors, management and outcomes of coronary perforations

Coronary Artery Perforation and Tamponade　― Incidence, Risk Factors, Predictors and Outcomes From 12 Years’ Data of the SCAAR Registry ―

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

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Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

Cited by 107 publications

References 30 publications

Incidence, predictors, management and outcomes of coronary perforations

Incidence, predictors, management and outcomes of coronary perforations

Coronary Artery Perforation and Tamponade ― Incidence, Risk Factors, Predictors and Outcomes From 12 Years’ Data of the SCAAR Registry ―

Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies

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Coronary Artery Perforation and Tamponade　― Incidence, Risk Factors, Predictors and Outcomes From 12 Years’ Data of the SCAAR Registry ―