Tim Kinnaird1, Richard Anderson2, Nicholas Ossei-Gerning2, James Cockburn2, Alex Sirker2, Peter Ludman2, Mark deBelder2, Simon Walsh2, Elliot Smith2, Colm Hanratty2, James Spratt2, Julian Strange2, David Hildick-Smith2, Mamas A Mamas2. 1. From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.). tim.kinnaird2@wales.nhs.uk. 2. From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.).
Abstract
BACKGROUND: Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited, and the long-term effects are unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during CTO-PCI were defined. METHODS AND RESULTS: Data analyzed from the British Cardiovascular Intervention Society data set on all CTO-PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. A total of 376 CP were recorded from 26 807 CTO-PCI interventions (incidence of 1.40%) with an increase in frequency during the study period (P=0.012). Patient-related factors associated with an increased risk of CP were age and female sex. Procedural factors indicative of complex CTO intervention strongly related to an increased risk of CP with a close relationship between the number of complex strategies used and CP evident (P=0.008 for trend). Tamponade occurred in 16.6% and emergency surgery in 3.4% of cases. Adverse outcomes were frequent in those patients with perforation including bleeding, transfusion, myocardial infarction, and death. A legacy effect of perforation on mortality was evident, with an odds ratio for 12-month mortality of 1.60 for perforation survivors compared with matched nonperforation survivors without a CP (P<0.0001). CONCLUSIONS: Many of the factors associated with an increased risk of CP were related to CTO complexity. Perforation was associated with adverse outcomes, with a legacy effect on later mortality after CP also observed.
BACKGROUND: Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited, and the long-term effects are unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during CTO-PCI were defined. METHODS AND RESULTS: Data analyzed from the British Cardiovascular Intervention Society data set on all CTO-PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. A total of 376 CP were recorded from 26 807 CTO-PCI interventions (incidence of 1.40%) with an increase in frequency during the study period (P=0.012). Patient-related factors associated with an increased risk of CP were age and female sex. Procedural factors indicative of complex CTO intervention strongly related to an increased risk of CP with a close relationship between the number of complex strategies used and CP evident (P=0.008 for trend). Tamponade occurred in 16.6% and emergency surgery in 3.4% of cases. Adverse outcomes were frequent in those patients with perforation including bleeding, transfusion, myocardial infarction, and death. A legacy effect of perforation on mortality was evident, with an odds ratio for 12-month mortality of 1.60 for perforation survivors compared with matched nonperforation survivors without a CP (P<0.0001). CONCLUSIONS: Many of the factors associated with an increased risk of CP were related to CTO complexity. Perforation was associated with adverse outcomes, with a legacy effect on later mortality after CP also observed.
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Authors: Rafał Januszek; Leszek Bryniarski; Zbigniew Siudak; Krzysztof P Malinowski; Krzysztof L Bryniarski; Andrzej Surdacki; Artur Dziewierz; Piotr Mika; Wojciech Wańha; Wojciech Wojakowski; Jarosław Wójcik; Jacek Legutko; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2020-12-29 Impact factor: 1.426
Authors: Majd B Protty; Sean Gallagher; Andrew S P Sharp; Vasim Farooq; Mohaned Egred; Peter O'Kane; Peter Ludman; Mamas A Mamas; Tim Kinnaird Journal: J Interv Cardiol Date: 2022-03-15 Impact factor: 2.279