Characteristics of Coronary Intra- or Extramedial Hematomas Causing Emergent Return to Catheterization Laboratory...

Coronary hematomas after percutaneous coronary intervention (PCI) may cause emergent ischemic events, but predictors remain unclear.

The aim of this study was to determine prognostic predictors of emergent ischemic events in intravascular ultrasound (IVUS)-defined hematomas.

In this single-center, retrospective, observational study, PCIs performed over 17 years were analyzed. Causes of emergent return to the catheterization laboratory within 1 month were identified. The analysis was then focused on patients who underwent IVUS-guided PCI for de novo native coronary arteries in whom hematomas were considered the primary cause. A hematoma was defined as stagnant blood or thrombus within a longitudinally dissected closed space and was subcategorized as intra- or extramedial. Patients requiring emergent catheterization with IVUS-identified hematomas (emergent event cohort) were compared with stable post-PCI patients with hematomas identified at the end of the index PCI (control cohort).

Among 40,934 PCIs performed from 2007 to 2023, 194 patients (0.47%) required emergent return. The emergent and control cohorts included 22 and 80 patients, respectively. Hematomas accounted for 24 of 122 ischemic causes (20%), second only to stent thrombosis (61 of 122 [50%]), and was the leading ischemic cause within 24 hours. Morphologic features associated with an emergent event included an extramedial hematoma (vs intramedial; OR: 4.66; 95% CI: 1.27-17.1), larger hematoma angle (per 90°; OR: 4.11; 95% CI: 1.47-11.5), a hematoma ending in a normal artery without a branch (OR: 5.28; 95% CI: 1.36-20.5), and greater hinge motion at the stent edge (per 5°; OR: 1.96; 95% CI: 1.10-3.50). One-half of the emergent patients experienced myocardial infarction.

Recognition of hematomas is critical to prevent emergent ischemic events.