Author + information
- Rafael Romaguera1,
- Agustin Fernández Cisnal2,
- Marcos Ñato3,
- Josep Gomez Lara4,
- Jose Luis Ferreiro5,
- Gerard Roura Ferrer6,
- Ana Lucrecia Marcano7,
- Lara Fuentes8,
- Joan Antoni Gomez-Hospital9 and
- Angel Cequier10
- 1Interventional Cardiologist, Barcelona, Spain
- 2Hospital Bellvitge, Barcelona, Spain
- 3Bellvitge Universitary Hospital., Barcelona, Spain
- 4Hospital Universitari de Bellvitge, Hospitalet De Llobregat, Spain
- 7hospital de bellvitge
- 8Hospital de Bellvitge
- 10Bellvitge University Hospital, Barcelona, Spain
It is unknown how progresses in interventional cardiology in the last decade have affected the occurrence of coronary perforations (CP). This study aimed to compare temporal trends in frequency, management and outcomes of CP.
All cases of CP recorded in our prospective institutional percutaneous coronary interventions (PCI) registry from 2003 to 2015 were included. Patients were divided in 2 groups according to the time frame in which the CP occurred: initial period (before 2009, when chronic total occlusions and primary PCI programs started) and current period. The primary endpoint was the composite of in-hospital serious events, including final TIMI flow 0-1, cardiac tamponade, emergent cardiac surgery or death.
Overall, 88 CP occurred in 17,566 procedures (0.50%). Of these, 17(0.26%) occurred during the initial period and 71(0.64%) during the current period (p<0.001). CP management differed between groups, being less proportion of CP sealed by intracoronary devices in the initial period than in the current one (23.5% vs 47.9%, p=0.068). Moreover, patients with CP during the initial period experienced more in-hospital serious events (69%vs31% respectively, OR 3.18, 95%CI 1.07-9.45, p=0.037) (Figure).
Expansion of indications and complexity of PCI in the current era may be associated to an increased frequency of CP. However, progresses in techniques and devices have entailed a remarkable improvement in the prognosis of this feared complication.