title: Incidence, Determinants, and Outcomes of Coronary Perforation During Percutaneous Coronary Intervention in the United Kingdom Between 2006 and 2013: An Analysis of 527 121 Cases From the British Cardiovascular Intervention Society Database.
abstract: As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database, the incidence, predictors, and outcomes of CP as a complication of PCI were defined.
  
  
  
  Data were prospectively collected and retrospectively analyzed from the British Cardiovascular Intervention Society data set on all PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. In total, 1762 CPs were recorded from 527 121 PCI procedures (incidence of 0.33%). Patients with CP were more often women or older, with a greater burden of comorbidity and underwent more complex PCI procedures. Factors predictive of CP included age per year (odds ratio [OR], 1.03; 95% confidence intervals, 1.02-1.03; P<0.001), previous coronary artery bypass graft (OR, 1.44; 95% confidence intervals, 1.17-1.77; P<0.001), left main (OR, 1.54; 95% confidence intervals, 1.21-1.96; P<0.001), use of rotational atherectomy (OR, 2.37; 95% confidence intervals, 1.80-3.11; P<0.001), and chronic total occlusions intervention (OR, 3.96; 95% confidence intervals, 3.28-4.78; P<0.001). Adjusted odds of adverse outcomes were higher in patients with CP for all major adverse coronary events, including stroke, bleeding, and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type.
  
  
  
  Using a national PCI database for the first time, the incidence, predictors, and outcomes of CP were defined. Although CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes.
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.). tim.Kinnaird2@wales.nhs.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Mark
authors.initials: M
authors.lastname: deBelder
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors
keywords: atherectomy, coronary; percutaneous coronary intervention; propensity score; stents; stroke