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.