Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry).
Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality.
Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany. Electronic address: bauer-timm@gmx.de.
Timm
T
Bauer
Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
Niklas
N
Boeder
Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
Holger M
HM
Nef
Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
Helge
H
Möllmann
Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany.
Matthias
M
Hochadel
Department of Cardiology, Cardio-Thoracic Center of Monaco, Monaco, Monaco.
Jean
J
Marco
Department of Cardiology, Rudolfstiftung Hospital, Vienna, Austria.
Franz
F
Weidinger
Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany; Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany.
Uwe
U
Zeymer
Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany; Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany.
Anselm K
AK
Gitt
Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany; Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
Christian W
CW
Hamm
D000368:Aged; D015992:Body Mass Index; D002305:Cardiac Tamponade / Q000209:etiology*; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000293:injuries*; D005062:European Union / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome