British Analysis Defines Determinants and Outcomes of Coronary Perforation During PCI

August 8, 2016—Tim Kinnaird, MD, et al defined the incidence, determinants, and outcomes of coronary perforation during percutaneous coronary intervention (PCI) in the United Kingdom between 2006 and 2013 by conducting an analysis of 527,121 cases from the British Cardiovascular Intervention Society (BCIS) database. The study, which was conducted on behalf of the BCIS and the United Kingdom’s National Institute for Cardiovascular Outcomes Research, is available online ahead of print in Circulation: Cardiovascular Interventions.

The background of the study is that coronary perforation is a rare but serious complication of PCI but the current evidence base is limited to small series.

As summarized in Circulation: Cardiovascular Interventions, the investigators prospectively collected and retrospectively analyzed data from the BCIS data set on all PCI procedures performed in England and Wales between 2006 and 2013. They used multivariate logistic regressions and propensity scores to identify predictors of coronary perforation and its association with outcomes.

There were 1,762 coronary perforations that were recorded from 527,121 PCI procedures (incidence of 0.33%). Patients with coronary perforations were more often female, older, with a greater burden of comorbidity, and underwent more complex PCI procedures.

The investigators reported that factors predictive of coronary perforation included age per year (odds ratio [OR], 1.03; 95% confidence intervals [CI], 1.02–1.03; P < .001), previous coronary artery bypass graft (OR, 1.44; 95% CI, 1.17–1.77; P < .001), left main (OR, 1.54; 95% CI, 1.21–1.96; P < .001), use of rotational atherectomy (OR, 2.37; 95% CI, 1.8–3.11; P < .001), and chronic total occlusions intervention (OR, 3.96; 95% CI, 3.28–4.78; P < .001).

Adjusted odds of adverse outcomes were higher in patients with coronary perforation 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 coronary perforation included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type. Although coronary perforation as a complication of PCI occurred rarely, it was strongly associated with poor outcomes, concluded the investigators in Circulation: Cardiovascular Interventions.