Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry)
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Published on: May 26, 2023
Timm Bauer1, Niklas Boeder1, Holger M Nef1
1Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
Insights
Coronary perforation (CP) during percutaneous coronary intervention (PCI) is rare but serious. This complication is linked to complex PCI procedures and significantly increases in-hospital mortality risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Coronary perforation (CP) is a rare but severe complication of percutaneous coronary intervention (PCI).
- Limited data exists on the incidence, determinants, and clinical outcomes of CP.
- Understanding CP is crucial for improving patient safety during PCI procedures.
Purpose of the Study:
- To investigate the incidence, determinants, and risk profile of CP in a large, prospective registry.
- To compare outcomes between patients with and without CP during PCI.
- To identify independent predictors of CP during complex coronary interventions.
Main Methods:
- Prospective enrollment of 42,068 patients undergoing PCI across 175 centers in 33 countries (2005-2008).
- Comparison of 124 patients with CP against those without CP.
- Statistical analysis to identify independent factors associated with CP and its impact on mortality.
Main Results:
- The incidence of CP was low at 0.3% (124 patients).
- Patients with CP were older, more often female, had severe coronary disease, and underwent complex PCI.
- Independent predictors included rotablation, intravascular ultrasound guidance, bypass PCI, totally occluded vessels, type C lesions, peripheral arterial disease, and low BMI.
- Cardiac tamponade occurred in over 10% of CP patients; 3.3% required emergency bypass surgery.
- In-hospital mortality was significantly higher in patients with CP (7.3% vs 1.5%).
Conclusions:
- CP is an infrequent complication of PCI, predominantly occurring during complex interventions.
- CP is associated with a fivefold increase in hospital mortality, independent of the EuroHeart score.
- These findings highlight the importance of recognizing risk factors and managing CP effectively to improve patient outcomes.
Abstract:
Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality.
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