Coronary perforation in the drug-eluting stent era: incidence, risk factors, management and outcome: the UK experience

Abstract

Despite treatment of more complex disease, the incidence of coronary perforation has not increased. Major perforations (Ellis class III) are associated with a high rate of emergency coronary artery bypass graft (CABG) and death. Endovascular treatments allow sealing of the perforation in most cases and deaths occur primarily as a result of cardiogenic shock due to occlusion of the culprit artery. Patient risk factors associated with perforation should be considered when planning or performing PCI.

Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry)

“…This is in line with data from a number of previous studies, 1,3,8,12,13 but there are other reports with a much higher incidence. 2,4,5,7 A possible explanation for the low incidence in the present study is that mainly high-volume centers with a mean annual PCI volume of 1,000 cases participated in the EHS PCI Registry.…”

“…In contrast to other analyses, female gender and age were not significant predictors. 2,5 In our analysis, adjunctive antithrombotic therapy did not have an influence on the occurrence of CP. In another study, a higher incidence of CP was observed in patients on glycoprotein IIb/IIIa antagonists.…”

“…It has been suggested in many studies that CP is more prevalent in chronic total occlusions and other complex lesions. 2,5,7,12 It was somewhat surprising, however, that PCI of coronary artery bypass grafts was independently associated with CP; one can only speculate about the reasons, 16 but advanced degeneration and the thinner vessel wall of venous bypass grafts in comparison with coronary arteries could have played a role.…”

“…The use of atheroablative devices has been shown by others to increase the risk of CP. 2,5,12 Rotational atherectomy is mainly used in heavily calcified lesions. 14 It can be assumed that both the procedure itself and the specific lesion characteristics contributed to the markedly increased risk of CP.…”

Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013

“…The largest published series describes 124 events, and the total literature is <1000 cases. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Given the small numbers of events per published series, it has not been possible to examine several key questions relating to the occurrence and outcomes of CP. First, it is unclear from the available evidence what the true incidence of CP is and whether its incidence increasing or decreasing.…”