Javaid Aamir, Buch Ashesh N, Satler Lowell F, Kent Kenneth M, Suddath William O, Lindsay Joseph, Pichard Augusto D, Waksman Ron
Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2006 Oct 1;98(7):911-4. doi: 10.1016/j.amjcard.2006.04.032. Epub 2006 Aug 7.
Coronary perforation is a particularly feared complication of percutaneous coronary intervention. The optimal management and predictors of adverse outcomes for these patients remain to be defined. Advances in management such as the use of polytetrafluoroethylene-covered stents have not been critically examined in terms of efficacy. We analyzed a cohort of patients who sustained coronary perforation during percutaneous coronary intervention at our institution during a 9-year period to examine the trends in incidence, management, and outcomes. The patient medical records were reviewed, and detailed angiographic analysis was undertaken to identify the predictors of adverse outcomes, including the development of tamponade, the requirement for emergency coronary artery bypass grafting, and in-hospital death. One year of follow-up was attempted for all patients. Seventy-two cases of coronary perforation were identified, with an overall incidence of 0.19%. The perforation grade and presence of chronic renal insufficiency were the only predictors of mortality on multivariate regression analysis. The use of polytetrafluoroethylene-covered stents to manage perforations was not associated with any reduction in adverse outcomes, such as the development of tamponade, the need for emergency coronary artery bypass grafting, or in-hospital death. In conclusion, coronary perforation remains a feared complication in the contemporary interventional era with significant in-hospital mortality. Emphasis should be placed on preventing this complication whenever possible, including exercising particular caution in patients with chronic renal insufficiency. The treatment of such patients should be tailored to the severity of the perforation. The optimal treatment of these patients needs to be defined, and the efficacy of covered stents needs to be studied prospectively.
冠状动脉穿孔是经皮冠状动脉介入治疗中一种特别令人担忧的并发症。这些患者不良结局的最佳管理方法和预测因素仍有待确定。诸如使用聚四氟乙烯覆膜支架等管理方面的进展，尚未在疗效方面进行严格审查。我们分析了在9年期间于我们机构接受经皮冠状动脉介入治疗时发生冠状动脉穿孔的一组患者，以研究发病率、管理方法和结局的趋势。查阅了患者的病历，并进行了详细的血管造影分析，以确定不良结局的预测因素，包括心包填塞的发生、紧急冠状动脉旁路移植术的需求和住院死亡。对所有患者尝试进行了一年的随访。共确定了72例冠状动脉穿孔病例，总发病率为0.19%。在多变量回归分析中，穿孔分级和慢性肾功能不全的存在是仅有的死亡率预测因素。使用聚四氟乙烯覆膜支架处理穿孔与不良结局的任何减少均无关，如心包填塞的发生、紧急冠状动脉旁路移植术的需求或住院死亡。总之，在当代介入治疗时代，冠状动脉穿孔仍然是一种令人担忧的并发症，具有显著的住院死亡率。应尽可能强调预防这种并发症，包括对慢性肾功能不全患者格外谨慎。此类患者的治疗应根据穿孔的严重程度进行调整。这些患者的最佳治疗方法需要确定，覆膜支架的疗效需要进行前瞻性研究。
