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      Incidence, risk factors, management and outcomes of coronary artery perforation during percutaneous coronary intervention.

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          Abstract

          Coronary artery perforation (CP) is a rare, sometimes lethal complication of percutaneous coronary intervention. There are limited controlled contemporary data regarding its predictors, incidence, and outcomes. The aim of this study was to define the incidence, associated factors, and outcomes of CP in the current era of coronary intervention. All patients who had CP during percutaneous coronary intervention at a large tertiary center from January 2001 to December 2008 were identified. Demographic, clinical, and procedural data and outcome variables were obtained. Patients with CP were compared with a randomly assigned control group. Fifty-seven patients with CP were identified among 9,568 interventions performed during the study period (0.59%); these patients were compared with 171 who underwent percutaneous coronary intervention without CP. Vessels were perforated by wires (52.6%), balloons (26.3%), and stents (21.1%). Perforations were classified using the Ellis classification. CP was associated with mortality and tamponade rates of 7% and 16%, respectively, but all these serious complications occurred with grade III perforations. Most grade I and II perforations were managed conservatively. Multivariate analysis identified the treatment of chronic total occlusion as the strongest independent predictor of CP; other independent variables included calcium in the coronary artery that was the site of intervention and non-ST elevation myocardial infarction.

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          Author and article information

          Journal
          Am J Cardiol
          The American journal of cardiology
          Elsevier BV
          1879-1913
          0002-9149
          Dec 15 2009
          : 104
          : 12
          Affiliations
          [1 ] Department of Cardiology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er Sheva, Israel. ashimony@bgu.ac.il
          Article
          S0002-9149(09)01480-5
          10.1016/j.amjcard.2009.07.048
          19962473
          8a95a1e0-c34c-4f77-bcee-22cb2c9c99a1
          History

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