Abstract 11429: Coronary Perforation During Percutaneous Coronary Intervention in Current Era
Background: Coronary perforation is a rare but critical complication of percutaneous coronary intervention (PCI). There is little information about the incidence of coronary perforation in the current era.
Methods and Results: Between July 2003 and April 2013, 4,196 patients underwent PCI. Grade II or III coronary perforation occurred in 50 patients (1.2%). Of these, 22 lesions (44%) were chronic total occlusion. There were 20 grade II and 30 grade III coronary perforations. They were caused with hydrophilic coated guidewires in 34 (68%), balloon inflation in 8 (16%), stent implantation in 5 (10%), rotational atherectomy in 2 (4%), and microcatheter in 1 (2%). They were sealed by prolonged balloon inflation in 31 (62%), stent implantation in 5 (10%), covered-stent implantation in 2 (4%), lipid embolization in 5 (10%), thrombus embolization in 1 (2%), coil embolization in 1 (2%), and surgical repair in 3 (6%). Cardiac tamponade occurred in 8 patients (16%). Percutaneous cardiopulmonary support was required in 4 patients (8%). Of 50 patients, 3 (6%) died. Multivariate analysis showed surgical repair (p<0.001), cardiopulmonary support (p<0.001), emergent cases (p<0.001), and cardiac tamponade (p=0.01) as risk factors of death associated with coronary perforation.
Conclusions: Coronary perforation is still a challenging problem even in the current era, especially in the hospital PCI for chronic total occlusion was performed aggressively. However, cardiac death associated with coronary perforation is not so high.
- © 2013 by American Heart Association, Inc.