Coronary Artery Perforations Studied in Contemporary PCI

February 6, 2017—Jessica Parsh, MD, et al published findings from an investigation that sought to evaluate the incidence, risk factors, in-hospital and long-term outcomes, and predictors of mortality of coronary artery perforations (CAPs) in the contemporary percutaneous coronary intervention (PCI) era. Findings from the study are available online in Catheterization and Cardiovascular Interventions (CCI). The investigators concluded that CAP is a rare complication but is associated with high morbidity and mortality, especially in women; further investigation is warranted to determine why women fare worse after CAP.

As summarized in CCI, the investigators included 181,590 procedures performed at 47 hospitals in Michigan from January 2010 through December 2015. Endpoints evaluated included the incidence of CAP and its association with in-hospital outcomes. Logistic regression analysis was used to determine independent risk factors for CAP and to examine whether the effect of CAP on mortality varied by patient sex.

The investigators found that CAP occurred in 625 (0.34%) patients. Independent predictors for CAP included older age, peripheral arterial disease, presence of left ventricular dysfunction or cardiomyopathy, lower body mass index, pre-PCI insertion of a mechanical ventricular support device, treatment of complex lesions (type C), and treatment of chronic total occlusions, the latter of which was the strongest predictor of perforation (adjusted odds ratio [OR], 7.01; P < .001).

After adjusting for baseline risk, the incidence of adverse outcomes remained substantially greater in patients with a perforation, with an adjusted OR estimate of 5.00 for mortality (95% confidence interval [CI], 3.42–7.31; P < .001), 3.25 for acute kidney injury (95% CI, 2.30–4.58; P < .001), and 5.26 for transfusion (95% CI, 4.03–6.87; P < .001). Perforation was associated with a higher mortality in women than men (interaction P-value = .01), reported the investigators in CCI.