The impact of coronary perforation in percutaneous interventions involving the left main stem coronary artery in the United Kingdom 2007–2014: Insights from the British Cardiovascular Intervention Society database

Abstract

Background: Percutaneous coronary intervention (PCI) is increasingly utilized for treatment of coronary disease involving the unprotected left main stem (ULMS). However, no studies to date have examined the outcomes of such interventions when complicated by coronary perforation (CP). Methods: Using the British Cardiovascular Intervention society (BCIS) database, data were analyzed on all ULMS-PCI procedures complicated by CP in England and Wales between 2007 and 2014. Multivariate logistic regressions were used to identify predictors of ULMS CP and to evaluate the association between this complication and outcomes. Results: During 10,373 ULMS-PCI procedures, CP occurred more frequently than in non-ULMS-PCI (0.9 vs. 0.4%, p < .001) with a stable annual incidence. Covariates associated with CP included number of stents used, female gender, use of rotational atherectomy and chronic total occlusion (CTO) intervention. Adjusted odds of adverse outcomes for ULMS-PCI complicated by CP were higher for peri-procedural complications including cardiogenic shock, tamponade, side-branch loss, DC cardioversion, in-hospital major bleeding, transfusion requirement, and peri-procedural myocardial infarction. There were also significantly increased odds for in-hospital major adverse cardiac events (MACCE, OR 8.961, 95% CI [4.902-16.383]) and 30-day mortality (OR 5.301, 95% CI [2.741-10.251]). Conclusions: CP is an infrequent event during ULMS-PCI and is predicted by female gender, rotational atherectomy, CTO interventions or number of stents used. CP was associated with significantly higher odds of mortality and morbidity, but at rates similar to previously published all-comer PCI complicated by CP.

Management of Coronary Artery Perforation

“…Coronary artery perforation (CAP) is a rare complication of percutaneous coronary intervention (PCI) with an incidence of about 0.2-0.5% [1,2]. It is more common in complex PCI, such as chronic total occlusion (CTO) PCI (4%) [3], especially with retrograde approach (15%) [4], unprotected left main PCI (0.9%) [5], bypass graft PCI (0.32-0.68%) [6], and PCI in women and the elderly [7]. CAP is associated with high risk in-hospital and late major adverse cardiac events, as it can lead to cardiac tamponade, hemodynamic compromise and death [7].…”

Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

“…Coronary perforation due to the burr is the most serious complication in RA, and the incidence of perforation in RA is approximately 1-2% [98][99][100][101]. If coronary perforation occurs during RA, there would be a considerable risk of in-hospital death, especially the lesions involving left main coronary artery [102]. The risk of perforation highly depends on the lesion characteristics such as vessel tortuosity or eccentricity of calcification.…”