TCT-252 The incidence, determinants and outcomes of coronary perforation during percutaneous coronary intervention in the United Kingdom between 2006–2013: an analysis of 527,121 cases from the British Cardiovascular Intervention Society database

Abstract

C oronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) with an estimated incidence of ≈0.5%. 1 Entry of arterial blood into the pericardial space can lead to rapid elevation of the pericardial pressure and rapid hemodynamic compromise. Historically, urgent surgical drainage was a standard treatment, but the development of new technologies such as covered stents and embolization coils and new techniques such as thrombus and fat injection have allowed many perforations to be treated in the catheterisation laboratory without the need for surgical intervention. 2,3 However, despite improvements in interven-tional skills and equipment, PCIs are increasingly complex with a higher prevalence of multivessel disease, worsening comorbidities (such as increasing age and renal dysfunction), Background-As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database, the incidence, predictors, and outcomes of CP as a complication of PCI were defined. Methods and Results-Data were prospectively collected and retrospectively analyzed from the British Cardiovascular Intervention Society data set on all PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. In total, 1762 CPs were recorded from 527 121 PCI procedures (incidence of 0.33%). Patients with CP were more often women or older, with a greater burden of comorbidity and underwent more complex PCI procedures. Factors predictive of CP included age per year (odds ratio [OR], 1.03; 95% confidence intervals, 1.02-1.03; P<0.001), previous coronary artery bypass graft (OR, 1.44; 95% confidence intervals, 1.17-1.77; P<0.001), left main (OR, 1.54; 95% confidence intervals, 1.21-1.96; P<0.001), use of rotational atherectomy (OR, 2.37; 95% confidence intervals, 1.80-3.11; P<0.001), and chronic total occlusions intervention (OR, 3.96; 95% confidence intervals, 3.28-4.78; P<0.001). Adjusted odds of adverse outcomes were higher in patients with CP for all major adverse coronary events, including stroke, bleeding, and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type. Conclusions-Using a national PCI database for the first time, the incidence, predictors, and outcomes of CP were defined. Although CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes. (Circ Cardiovasc Interv. 2016;9:e003449.

Outcome after new generation single‐layer polytetrafluoroethylene‐covered stent implantation for the treatment of coronary artery perforation

“…Although, delivery to the target lesion was successful in all cases, conversion to surgical repair was needed in two cases, due to vessel rupture which could not be sealed with CS, resulting in an overall technical success rate of 96.7%. Despite high technical success rates, in hospital mortality and procedure related MI rates in this study did not differ from previous reports . This underlines the severity of CAPs as periprocedural complication and its aftermaths.…”

“…The reported incidence of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) is low, ranging from 0.3% to 3%. [1][2][3][4][5][6] However, the growing percentage of PCI in very complex lesions including chronic total occlusions (CTOs) or heavy calcification might also entail an increase of the incidence of this complication. 7,8 When CAP occurs, it is a serious complication, associated with high mortality rates, ranging from 7% to 44%.…”

Predictors of in‐hospital effectiveness and complications of rotational atherectomy (from the ORPKI Polish National Registry 2014–2016)

“…The frequency of CAP was similar in our population of patients undergoing RA, whereas coronary artery dissection rate was almost ten times higher compared with our group. Kinnaird et al demonstrated that among the significant predictors of CAP in the overall group comprising of more than 500,000 patients undergoing PCIs from the national registry in the United Kingdom were age, previous CABG, PCI of LMCA, RA, and CTO . Previously, published data from the ORPKI registry revealed an increased number of CAPs in patients with PCI and BVS in comparison to those with DES/BMS.…”

Hope for the best, prepare for the worst: How to manage coronary perforations

“…Coronary perforation is a relatively rare complication of percutaneous coronary intervention (PCI). However, its reported incidence varies widely and ranges from 0.3 to 4.0% . Perforations occur more frequently in complex coronary interventions, which has important implications for contemporary PCI as the proportion of complex PCI (e.g., heavily calcified lesions, chronic total occlusions [CTOs], last remaining vessel) is increasing.…”

“…However, given the low number of coronary perforations in the present analysis, the study lacked power to adequately identify predictors of this procedural complication. A previous analysis of 1,762 perforations in 527,121 cases from the British Cardiovascular Intervention Society Database identified the following predictors: age, left main coronary intervention, use of rotational atherectomy, and CTO interventions …”