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Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study
Thomas J Ford1,2,3, Carly Adamson1,2, Andrew J Morrow1,2
1West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK.
Insights
Coronary artery perforations during percutaneous coronary intervention increased from 2001-2019. Severe perforations led to worse outcomes, while early covered stents showed a high risk of stent thrombosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary artery perforation is a rare but serious complication of percutaneous coronary intervention (PCI).
- Understanding temporal trends and outcomes of PCI-related perforations is crucial for improving patient care.
- Covered stents are used to manage complex coronary perforations, but their long-term outcomes require evaluation.
Purpose of the Study:
- To report the incidence and outcomes of coronary artery perforations over an 18-year period.
- To analyze temporal trends in coronary perforation incidence.
- To evaluate the long-term outcomes of covered stent deployment for coronary perforations.
Main Methods:
- Retrospective analysis of 43,343 consecutive PCI procedures from 2001-2019.
- Classification of coronary perforations using the Ellis grading system.
- Assessment of procedural and long-term clinical outcomes, including major adverse cardiac events and stent thrombosis.
Main Results:
- The incidence of coronary perforation increased significantly over the study period (0.37% overall).
- Severe perforations (Ellis grade III/IIIB) were strongly associated with higher procedural mortality and major adverse cardiac events.
- Covered stent use was associated with a significantly increased risk of stent thrombosis at 2.9-year follow-up (9.1% vs. 0.9%).
Conclusions:
- Coronary perforation incidence rose between 2001 and 2019, highlighting a need for improved prevention and management strategies.
- Severe perforations are independent predictors of long-term mortality and adverse cardiac events.
- While effective for acute management, early-generation covered stents carry a substantial risk of late stent thrombosis, necessitating further device development.
Abstract:
Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (r=0.73; P<0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), P<0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; P<0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; P=0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Clinicaltrials.gov. Identifier: NCT03862352.
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