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Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival

Ioannis Stathopoulos1, Konstantinos Kossidas, Georgia Panagopoulos

  • 1Lenox Hill Hospital, Heart and Vascular Institute of New York, Department of Cardiac and Vascular Interventional Services, New York, USA. jastathopoulos@hotmail.com.

The Journal of Invasive Cardiology
|October 4, 2013
PubMed

Insights

Cardiac tamponade after coronary perforation during percutaneous coronary intervention significantly increases mortality risk. Caution is advised for non-elective PCI on complex lesions due to higher risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Complications

Background:

  • Cardiac tamponade is the most severe complication of coronary perforation (CP) during percutaneous coronary intervention (PCI).
  • Coronary perforation occurs in 0.31% of PCI procedures, with tamponade developing in 0.11%.

Purpose of the Study:

  • To evaluate the impact of cardiac tamponade on mortality following coronary perforation during PCI.
  • To compare outcomes between patients with CP and tamponade versus those with CP alone.

Main Methods:

  • Analysis of 23,399 PCI procedures, identifying 73 cases of CP (26 with tamponade).
  • Comparison of patient characteristics and outcomes between CP with tamponade (Group A) and CP without tamponade (Group B).
  • Development of a multivariate model to assess tamponade's independent effect on mortality.

Main Results:

  • Tamponade increased the risk of death by over 3-fold (OR=3.3; P=.047).
  • CP with tamponade during non-elective PCI had a significantly worse long-term prognosis (P=.001).
  • Coil embolization was more frequent in the tamponade group (P=.003); emergent surgery was required in 11.5% of Group A vs. 2.1% of Group B.

Conclusions:

  • Cardiac tamponade complicating CP during PCI leads to significant short- and long-term adverse effects.
  • Despite decreased in-hospital mortality and emergent surgery rates, tamponade remains a major risk factor for death.
  • PCI for complex lesions, especially in non-elective cases, requires caution due to increased perforation and mortality risks.
Abstract

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