Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures.
BACKGROUND
Coronary perforation is a serious but uncommon complication of percutaneous coronary intervention (PCI) and is associated with significant morbidity and mortality.


METHODS
We performed an analysis of the Mayo Clinic PCI database. Clinical records, procedural reports, and angiographic studies were reviewed. Multiple logistic regression analysis was performed to identify clinical, procedural, anatomic, and angiographic correlates of coronary perforation.


RESULTS
A total of 16,298 PCI procedures were performed between January 1990 and December 2001. We identified 95 coronary perforations (0.58%; 95% CI, 0.47-0.71). The incidence of coronary perforation varied with time. Correlates of coronary perforation included the use of an atheroablative device and female sex. Twelve patients (12.6%) sustained an acute myocardial infarction, and cardiac tamponade developed in 11 patients (11.6%). Management strategies included reversal of heparin, pericardiocentesis, placement of a covered stent, and surgical repair. Seven patients died (7.4%).


CONCLUSIONS
Coronary perforation during PCI is rare, but is associated with significant morbidity and mortality. The variable frequency of perforation may be explained by temporal variations in the use of atheroablative devices.
Fasseas
Panayotis
P
Division of Cardiovascular Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Orford
James L
JL
Panetta
Carmelo J
CJ
Bell
Malcolm R
MR
Denktas
Ali E
AE
Lennon
Ryan J
RJ
Holmes
David R
DR
Berger
Peter B
PB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary / Q000009:adverse effects; D003250:Constriction; D003324:Coronary Artery Disease / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use; D012044:Regression Analysis; D015607:Stents / Q000009:adverse effects; D014950:Wounds, Penetrating / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy
D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011479:Protamines