Abstract 19456: Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Coronary Artery Injury During Percutaneous Coronary Intervention
Background: Iatrogenic coronary artery injuries result in life-threatening complications such as coronary artery dissection and/or perforation, stent dislocation causing coronary artery occlusion, and retrograde coronary dissection precipitating Type A aortic dissection (TAAD). Complications not amenable to or unsuccessfully treated with by non-surgical interventions necessitate emergent surgical management.
Objectives: To evaluate the early and long-term outcomes in patients undergoing surgical treatment following iatrogenic complications during percutaneous coronary interventions (PCI).
Methods and Results: A total of 168 consecutive patients underwent surgical treatment of iatrogenic complications following PCI between December 1999 and July 2015 in our institution. Of these, 133 patients underwent PCI in our hospital, whereas 35 patients were transferred from referral centers. Mean age was 68.5±10.2 years and 64.3% were males. The left anterior descending artery was injured in 65 patients (38.7%) and left main stem in 17 patients (10.1%). TAAD was diagnosed in 13 patients and 30 patients (17.9%) developed cardiac tamponade. Overall, 102 patients (60.7%) developed myocardial infarction and 77 patients (45.8%) developed cardiogenic shock. Coronary artery bypass graft surgery was performed in 147 patients (87.5%); 13 underwent ascending aortic/ arch repair for TAAD and 26 underwent pericardiotomy for cardiac tamponade. In-hospital mortality was 19.6% and was independently predicted by left ventricular ejection fraction (LVEF) (Odds ratio [OR]:1.2;p<0.001) and preoperative critical state (OR:7.0;p<0.001). A total of 56 patients died during follow-up. The 5-year survival was 68.4±7%. Risk factors for long-term mortality were LVEF (Hazard ratio [HR]:1.2;p=0.005) and preoperative cerebrovascular accident (CVA) (HR:4.5;p=0.046).
Conclusions: Iatrogenic coronary artery injuries requiring surgical interventions are associated with a high in-hospital and long-term mortality despite immediate surgical treatment. Patients with LV dysfunction predict early and late mortality, with the former being additionally influenced by critical preoperative state and the latter by preoperative CVA.
Author Disclosures: A. Verevkin: None. P. Davierwala: None. N. Mangner: None. K. von Aspern: None. F. Bakhtiary: None. M. Misfeld: None. F.W. Mohr: None.
- © 2016 by American Heart Association, Inc.