title: Outcomes of coronary arterial perforations during percutaneous coronary intervention with bivalirudin anticoagulation.
abstract: Coronary perforation (CP) is a rare but catastrophic event that may be influenced by the procedural anticoagulation regimen. This study compared the consequences of CP in patients who underwent anticoagulation with bivalirudin (BIV; a nonreversible direct thrombin inhibitor with a shorter 1/2-life than heparin) to those in patients who underwent anticoagulation with heparin (HEP) at time of CP. Patients with CP were identified from 33,613 procedures available in our institutional angioplasty registry. The outcome of this group was compared based on anticoagulation regimen (BIV vs HEP). The primary end point for this analysis was the composite of in-hospital death, cardiac tamponade, or emergency cardiac surgery. Overall a cohort of 69 patients (0.2%) with CP was identified. BIV was the intraprocedural anticoagulant in 41 patients, whereas HEP was used in 28. Baseline characteristics were comparable between groups except for a higher frequency of systemic hypertension and hypercholesterolemia in the BIV group. Procedural characteristics were also similar including lesion complexity and perforation severity. Nearly 1/2 of CPs in each group was managed with prolonged balloon inflation alone. Protamine was used in 46% of HEP-treated patients. Covered stents tended to be used more frequently in the BIV group (p = 0.061). The primary composite end point was similar between groups (odds ratio 1.42, 95% confidence interval 0.47 to 4.29, p = 0.53). However, there was a lower rate of cardiac surgery requirement in BIV-treated patients (p = 0.037). In conclusion, our study suggests that choice of procedural anticoagulant agent does not influence outcome when CP occurs. Therefore, use of BIV should not be discouraged in patients undergoing high-risk intervention for perforations.
authors.affiliation: Washington Hospital Center, DC, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Ana
authors.initials: A
authors.lastname: Laynez-Carnicero
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Camille
authors.initials: C
authors.lastname: Hauville
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000009:adverse effects; D007431:Intraoperative Complications; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012086:Reoperation; D015607:Stents; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin