title: Coronary artery perforations in the contemporary interventional era.
abstract: 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.
authors.affiliation: Division of Interventional Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Kiernan
authors.forename: B P
authors.initials: BP
authors.lastname: Yan
authors.forename: N
authors.initials: N
authors.lastname: Ruggiero
authors.forename: J D
authors.initials: JD
authors.lastname: Eisenberg
authors.forename: J
authors.initials: J
authors.lastname: Bernal
authors.forename: R J
authors.initials: RJ
authors.lastname: Cubeddu
authors.forename: C
authors.initials: C
authors.lastname: Witzke
authors.forename: C
authors.initials: C
authors.lastname: Don
authors.forename: I
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.forename: K
authors.initials: K
authors.lastname: Rosenfield
authors.forename: E
authors.initials: E
authors.lastname: Pomersantev
authors.forename: I
authors.initials: I
authors.lastname: Palacios
mesh_terms: 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