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Coronary Perforation Occurring During Percutaneous Coronary Intervention Is Associated With Persistently High
Mohammad Reza Movahed1,2, Nishant Satapathy1, Mehrtash Hashemzadeh1
1From the Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
Insights
Coronary perforation during percutaneous coronary intervention (PCI) leads to significantly higher inpatient mortality (12.9%) compared to patients without perforation. These high mortality rates persist, indicating a need for improved PCI perforation management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Patient Outcomes
Background:
- Coronary perforation is a serious complication of percutaneous coronary intervention (PCI).
- Understanding the outcomes associated with PCI-related coronary perforation is crucial for patient care.
- This study focuses on adverse events and mortality in patients experiencing coronary perforation during PCI.
Purpose of the Study:
- To evaluate adverse outcomes and mortality in patients aged 30 and above who experienced coronary perforation during PCI.
- To compare outcomes of patients with and without coronary perforation during PCI.
Main Methods:
- Utilized the National Inpatient Sample database from 2016-2020.
- Employed International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients.
- Compared outcomes between patients with and without coronary perforation during PCI.
Main Results:
- Out of 10,059,269 PCI procedures, 11,725 (0.12%) resulted in coronary perforation.
- Mortality rate for patients with perforation was 12.9% versus 2.5% for those without (OR 5.6).
- Patients with perforation experienced higher rates of urgent coronary bypass surgery, cardiac tamponade, cardiac arrest, and major adverse cardiovascular events.
Conclusions:
- All-cause inpatient mortality for coronary perforation during PCI remains high, exceeding 10%.
- Mortality rates have remained persistently high over the 5-year study period.
- Current treatments for PCI-related coronary perforation require significant improvement to reduce adverse outcomes.
Introduction:
Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30.
Methods:
The National Inpatient Sample database, years 2016-2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients suffering from perforation were compared with patients without perforation during PCI.
Results:
PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12%) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs. 2.5%, odds ratio, 5.6; CI, 5-6.3; P < 0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period.
Conclusions:
Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%), with persistently high mortality rates over the years, suggesting that treatment of perforations needs further improvement.
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