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Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and
Ramazan Gündüz1, Bekir Serhat Yıldız2, Nurullah Çetin2
1Department of Cardiology, Manisa City Hospital, Manisa, Turkey.
Insights
Coronary artery perforation during percutaneous coronary intervention is rare but serious. This Turkish study found a 0.22% perforation rate with high in-hospital mortality, particularly for severe perforations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Complications
Background:
- Coronary artery perforations are rare but severe complications of percutaneous coronary intervention (PCI).
- Limited data exists on coronary artery perforations within the Turkish population.
- This study addresses the need for localized data on this critical complication.
Purpose of the Study:
- To analyze clinical and angiographic characteristics of coronary artery perforations during PCI.
- To evaluate management strategies and outcomes for these perforations.
- To provide insights specific to the Turkish patient population over a decade.
Main Methods:
- Retrospective analysis of 48,360 PCI procedures from January 2010 to June 2020.
- Identification of 110 cases with coronary artery perforation via angiographic review.
- Detailed analysis of patient demographics, lesion types, perforation severity (Ellis classification), management, and outcomes.
Main Results:
- The coronary artery perforation rate was 0.22%.
- Left anterior descending artery and type C lesions were most frequently involved.
- Type III perforations (Ellis classification) were most common, with 52.7% receiving covered stents. In-hospital mortality was 18.1%.
Conclusions:
- The observed coronary artery perforation rate aligns with existing literature.
- However, in-hospital mortality rates in this cohort were higher than previously reported.
- Higher mortality was noted in severe (Type II and III) perforations, emphasizing the need for careful PCI in selected patients.
Background:
Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey.
Methods:
The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients.
Results:
The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%.
Conclusion:
The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.
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