Author + information
- tim kinnaird1,
- Chun Shing Kwok2,
- evan kontopantelis3,
- Ossei-Gerning Nick4,
- Peter Ludman5,
- Mark de Belder6,
- Richard Anthony Anderson7 and
- Mamas Mamas8
- 1UHW, penarth, United Kingdom
- 2Keele University, Stoke-on-Trent, United Kingdom
- 3Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum
- 4Cardiff and Vale NHS Trust, Cardiff, United Kingdom
- 5bham, United Kingdom
- 6The James Cook University Hospital, Middlesbrough, United Kingdom
- 7University Hospital Of Wales, Caerdydd, United Kingdom
- 8Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
Coronary perforation (CP) is a rare but serious complication of PCI but there is little data on the independent predictors and outcomes. A national PCI database was used to define the incidence, predictors and outcomes of CP as a complication of PCI.
Data were collected and analysed from the British Cardiovascular Intervention Society dataset on all PCI procedures performed in the UK between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes.
1,762 coronary perforations were recorded from 527,121 PCI procedures (overall CP incidence of 0.33%). Patients with CP were more often female (35.2 vs. 26.5%, p<0.001) or older (68.9±11.1 vs. 64.8±11.8, p<0.001), with a greater burden of co-morbidity such as hypertension (59.5 v. 50.7%, p<0.001), previous MI (37.2 vs. 26.5%, p<0001), previous CABG (14.3 vs. 8.1%, p<0.001), chronic kidney disease (2.5 vs. 3.7%, p<0.001), peripheral vascular disease (7.1 vs. 4.5%, p<0001), and ejection fraction <30% (6.0 vs. 8.0%, p<0.001). Patients with CP underwent complex PCI procedures with rotational atherectomy (6.1 vs. 2.2% p<0.001), laser atherectomy (1.3 vs. 0.2%, p<0.001), and CTO intervention (20.7 vs. 5.3%, p<0.001) all more frequent than those patients without CP. Factors independently predictive of CP included age (OR 1.03 for each year of age, 1.02-1.03, p<0.001), previous CABG (OR 1.44, 1.17-1.77, p<0.001), left main (OR 1.54, 1.21-1.96, p<0.001) use of rotational atherectomy (OR 2.37, 1.80-3.11, p<0.001) and CTO intervention (OR 3.96, 3.28-4.78, p<0.001). Adjusted odds of adverse outcomes were higher for all major adverse coronary events including in-hospital stroke (OR 4.30, 2.42-7.64, p<0.001), in-hospital bleeding (OR 20.86, 17.21-25.28, p<0,001), 30-day mortality (OR 4.86, 3.84-6.15, p<0.001) and 12-month mortality (OR 2.54, 2.08-3.09, p<0.001). Emergency surgery was required in 2.7% of cases. Predictors of mortality in patients with CP included age (OR 1.05 for each year of age, 1.03-1.08, p<0.001), diabetes (OR 1.78, 1.02-3.11, p=0.043), previous myocardial infarction (OR 2.08, 1.25-3.46, p=0.005), renal disease (OR 4.03, 1.76-9.26, p=0.001), and glycoprotein inhibitor use (OR 2.02, 1.19-3.44).
Using a national PCI database the incidence, predictors and outcomes of coronary perforation were conclusively defined. Although coronary perforation occurred as a complication of PCI rarely it was strongly associated with poor outcomes.