title: Coronary perforation in the drug-eluting stent era: incidence, risk factors, management and outcome: the UK experience.
abstract: OBJECTIVE
  Coronary perforation during percutaneous coronary intervention (PCI) is associated with a high risk of mortality and morbidity. However there has been little data on perforation in the current era despite significant changes in PCI practice. We set out to identify incidence, risk factors and management strategies of coronary perforation in the current era.
  
  
  RESULTS
  We performed a retrospective analysis of the Manchester Heart Centre PCI database from June 2004 to May 2008. Detailed analysis of all cases of suspected perforation was undertaken by case note and angiographic review. Demographic data was collected regarding all patients undergoing intervention. A total of 12,729 coronary lesions were treated in 7,903 patients over four years, during which drug-eluting stent (DES) uptake was 77%. The incidence of perforation was 0.56% (44/12,729). Perforation was associated with an inpatient mortality of 15.9% (7/44). Factors associated with perforation were female sex (p=0.003), increasing age (p<0.01), coronary calcification (p=0.003), use of a cutting balloon (p<0.001) or atheroablation (p<0.001), and treatment of a chronic total occlusion (p<0.01). Factors associated with death after perforation were non-elective procedure (p=0.036) and pericardial drain insertion (p<0.001).
  
  
  CONCLUSIONS
  Despite treatment of more complex disease, the incidence of coronary perforation has not increased. Major perforations (Ellis class III) are associated with a high rate of emergency coronary artery bypass graft (CABG) and death. Endovascular treatments allow sealing of the perforation in most cases and deaths occur primarily as a result of cardiogenic shock due to occlusion of the culprit artery. Patient risk factors associated with perforation should be considered when planning or performing PCI.
authors.affiliation: Lancashire Cardiac Centre, Blackpool, United Kingdom.
authors.forename: Cara
authors.initials: C
authors.lastname: Hendry
authors.forename: Doug
authors.initials: D
authors.lastname: Fraser
authors.forename: Jonas
authors.initials: J
authors.lastname: Eichhofer
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.forename: Farzin
authors.initials: F
authors.lastname: Fath-Ordoubadi
authors.forename: Magdi
authors.initials: M
authors.lastname: El-Omar
authors.forename: Paul
authors.initials: P
authors.lastname: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000293:injuries; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy