Coronary artery perforations in the contemporary interventional era.
BACKGROUND
Coronary perforations represent a serious complication of percutaneous coronary intervention (PCI).


METHODS
We performed a retrospective analysis of documented coronary perforations at Massachusetts General Hospital from 2000 to 2008. Medical records review and detailed angiographic analysis were performed in all patients.


RESULTS
Sixty-eight cases of coronary perforation were identified from a total of 14,281 PCIs from March 2000 to March 2008 representing an overall incidence of 0.48%. The study cohort was predominantly male (61.8%), mean age 71+/-11 years with 78% representing acute cases (unstable angina: 36.8%, NSTEMI: 30.9%, STEMI: 10.3%). Coronary artery perforation occurred as a complication of wire manipulation in 45 patients (66.2%) with 88.9% of this group being hydrophilic wires, of coronary stenting in 11 (16.2%), of angioplasty alone in 6 (8.8%), and of rotational atherectomy in 8 (11.8%). The perforation was sealed with an angioplasty balloon alone in 16 patients (23.5%), and with stents in 14 patients (20.6%) (covered stents: 11.8% and noncovered stents: 8.8%). Emergency CABG was performed in 2 patients (2.9%). Five patients (7.4%) developed periprocedural MI. The in-hospital mortality rate was 5.9% in the study cohort.


CONCLUSIONS
Coronary artery perforation as a complication of PCI is still rare as demonstrated in our series with an incidence of 0.48%. The predominant cause of coronary perforations in the current era of PCI is wire injury.
Kiernan
T J
TJ
Division of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Yan
B P
BP
Ruggiero
N
N
Eisenberg
J D
JD
Bernal
J
J
Cubeddu
R J
RJ
Witzke
C
C
Don
C
C
Cruz-Gonzalez
I
I
Rosenfield
K
K
Pomersantev
E
E
Palacios
I
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003324:Coronary Artery Disease; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors