Incidence, Predictors and Management of Coronary Artery Perforations in the Contemporary Era - A 10-year Dataset
Hamza Umar1, Ashwin Roy2, Mohammed Ali Osheiba1, Peter Ludman3, Jonathan Townend 4, Adnan Nadir3, Sagar Doshi3, Alexander Zaphiriou3, Sohail Khan5
Queen Elizabeth Hospital Birmingham, United Kingdom1, University Hospitals Birmingham NHS Foundation Trust, United Kingdom2, University Hospitals Birmingham, United Kingdom3, Queen Elizabeth, Univeristy Hospital Birmingham, United Kingdom, United Kingdom4, Queen Elizabeth Hospital, Great Britain (UK)5
Coronary artery perforation (CAP) is a rare complication of percutaneous coronary intervention (PCI), associated with advancing age, use of glycoprotein IIb/IIIa inhibitor and PCI on tortuous, calcified vessels and chronic total occlusions (CTO). This study aims to identify CAP predictors using contemporary data.
This was a retrospective cohort study analysing data on all PCIs performed at the Queen Elizabeth Hospital, Birmingham between January 2010 and October 2020. Patient demographics, comorbidities, modified Ellis perforation class and perforation treatment were collected. The CAP population was split into two cohorts (1 and 2), each representing a different 5-year period within the decade.
During a 10 year period, 9504 PCIs were performed, with 66 CAP cases identified. CAP incidence was 0.55% in the first half of the decade and 0.81% in the latter; overall incidence 0.69%. According to the Ellis criteria, 4.5% of CAPs were type I, 13.6% type II, 45,5% type III, and 34.8% type V. Management included the use of balloon inflation 27%, heparin reversal 4.5%, balloon inflation and heparin reversal 12%, stents 20, coils 12%, surgery 3%, coil and stent 1.5% and observation 20%. Overall mortality within the total perforation cohort was 14%. Emergency pericardiocentesis was required in 13 patients; in this group mortality was 46%.The difference in trends between the two cohorts is illustrated in the following table.
The data demonstrate an increased incidence of CAP and mortality in the second half of the decade. This may be explained by an increase in CTO, rotablation, and IVUS use (surrogates for complex PCI) and an older population with more comorbidities (CKD and diabetes). Cardiac tamponade was found to be a poor prognostic factor in those with CAP.