Abstract 14588: Trends, Predictors and Outcomes of Coronary Artery Perforation During Percutaneous Coronary Intervention: Insights From NCDR® Cath PCI Registry
Introduction: Coronary artery perforation (CAP) is a rare but dreaded complication of percutaneous coronary intervention (PCI). Our aim was to study trends, predictors and outcomes of CAP in the contemporary era.
Methods: We examined the NCDR Cath PCI registry between July 2009 and July 2015. Multivariable logistic regression was used to identify predictors of CAP and association with in-hospital adverse events.
Results: A total of 13,779 CAPs were identified in 3,759,268 patients undergoing PCI (0.37% incidence rate). Over the study period, annual PCI volume was largely unchanged while CTO PCI rates increased without a significant increase in rates of CAP (1.2%-1.5%) (Figure 1). In the multivariable model, CTO PCI was the strongest predictor of CAP (OR 2.59, 95% CI 2.39-2.8). Other significant predictors were female sex, SVG PCI, Type C lesion, cardiogenic shock, laser and atherectomy usage. Patients with CAP had a significantly higher in-hospital adjusted rate of cardiogenic shock 7.73%, tamponade 9.6% and death 4.87% compared to those without. The strongest multivariable predictors of any adverse events in CAP were cardiogenic shock (OR 3.93, 95% CI 3.05-5.07) and covered stent usage (OR 3.67, 95% CI 3.18-4.23). Other predictors of any adverse events were female sex, STEMI, NSTEMI, cardiac arrest, type C lesion, CTO PCI and atherectomy device usage. Use of bivalirudin alone resulted in less adverse events compared to heparin alone (OR 0.75, 95% CI 0.66-0.85) in patients with CAP. CAP with CTO PCI resulted in a total adverse event rate of 26.8% compared to CAP in non-CTO PCI 22.31%.
Conclusion: In this largest report to date of CAP, CTO PCI was the strongest predictor of CAP. CAP was associated with significantly increased risk of in hospital adverse events.
Author Disclosures: R. Nairooz: None. E. McNulty: None. A. Mohsen: None. C. Parzynski: None. J. Curtis: None. B. Uretsky: None. A. Hakeem: None.
- © 2016 by American Heart Association, Inc.