AIMS: We aimed to examine the prevalence, clinical outcomes and procedural characteristics of percutaneous coronary intervention (PCI) complicated by coronary artery perforation (CAP) in a contemporary patient population. METHODS AND RESULTS: Procedural records of 39,115 patients undergoing PCI between 2005 and 2016 were reviewed. CAP affected 149 cases (0.37%). The prevalence of CAP increased from 0.31% in 2005 to 0.45% in 2016 (p=0.03), reflecting an increase in more complex PCI (from 14% in 2005 to 21% in 2016; p<0.0001). CAP was associated with increased all-cause mortality (23.1% vs. 9.4% in those without perforation; p=0.0054) and was an independent predictor of mortality (HR 2.55; 95% CI: 1.34-4.78). In-patient mortality was 4% (6/149). In 43 of 149 (28.9%) cases, a significant pericardial effusion ensued and mortality rates were higher in this subgroup. Thirty-one patients had covered stents (CS) inserted and five did not survive to discharge. Of the 26 patients with a CS who survived to hospital discharge, six (23.1%) had definite stent thrombosis, and two (7.7%) had possible/probable stent thrombosis. CONCLUSIONS: CAP remains uncommon but the prevalence is increasing. CAP is associated with significant short- and long-term mortality, particularly when there is haemodynamic compromise necessitating pericardiocentesis. Covered stents are a valuable tool but they are associated with a high risk of stent thrombosis.
AIMS: We aimed to examine the prevalence, clinical outcomes and procedural characteristics of percutaneous coronary intervention (PCI) complicated by coronary artery perforation (CAP) in a contemporary patient population. METHODS AND RESULTS: Procedural records of 39,115 patients undergoing PCI between 2005 and 2016 were reviewed. CAP affected 149 cases (0.37%). The prevalence of CAP increased from 0.31% in 2005 to 0.45% in 2016 (p=0.03), reflecting an increase in more complex PCI (from 14% in 2005 to 21% in 2016; p<0.0001). CAP was associated with increased all-cause mortality (23.1% vs. 9.4% in those without perforation; p=0.0054) and was an independent predictor of mortality (HR 2.55; 95% CI: 1.34-4.78). In-patient mortality was 4% (6/149). In 43 of 149 (28.9%) cases, a significant pericardial effusion ensued and mortality rates were higher in this subgroup. Thirty-one patients had covered stents (CS) inserted and five did not survive to discharge. Of the 26 patients with a CS who survived to hospital discharge, six (23.1%) had definite stent thrombosis, and two (7.7%) had possible/probable stent thrombosis. CONCLUSIONS:CAP remains uncommon but the prevalence is increasing. CAP is associated with significant short- and long-term mortality, particularly when there is haemodynamic compromise necessitating pericardiocentesis. Covered stents are a valuable tool but they are associated with a high risk of stent thrombosis.
Authors: Alper Öner; Caroline Moerke; Anne Wolff; Sabine Kischkel; Wolfram Schmidt; Niels Grabow; Hüseyin Ince Journal: Eur J Med Res Date: 2020-07-29 Impact factor: 2.175
Authors: Wojciech Wańha; Rafał Januszek; Michalina Kołodziejczak; Łukasz Kuźma; Mateusz Tajstra; Tomasz Figatowski; Malwina Smolarek-Nicpoń; Monika Gruz-Kwapisz; Brunon Tomasiewicz; Jerzy Bartuś; Andrzej Łoś; Dariusz Jagielak; Tomasz Roleder; Adrian Włodarczak; Jan Kulczycki; Mariusz Kowalewski; Damian Hudziak; Paweł Stachowiak; Jarosław Gorący; Katarzyna Sierakowska; Krzysztof Reczuch; Miłosz Jaguszewski; Sławomir Dobrzycki; Grzegorz Smolka; Stanisław Bartuś; Andrzej Ochała; Mariusz Gąsior; Wojciech Wojakowski Journal: PLoS One Date: 2021-05-12 Impact factor: 3.240
Authors: Mohammed S Al-Omary; Nicholas J Collins; Jonathan G Sung; Rohan Bhagwandeen; Ka Hei Ho; Ping Wa Yam; Eugene B Wu; Ho Lam Journal: JACC Case Rep Date: 2022-02-02