Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Québec, Canada.
Can J Cardiol. 2011 Nov-Dec;27(6):843-50. doi: 10.1016/j.cjca.2011.04.014. Epub 2011 Aug 20.
Numerous studies have examined the incidence, predictors, outcomes, and management strategies of coronary artery perforation (CAP). Individually, these studies have been inconclusive because of their limited sample sizes and/or single-centre designs. We conducted a systematic review and meta-analysis of studies pertaining to CAP in order to estimate its incidence and outcomes and to critically review its risk factors and treatment. We systematically searched the literature to identify all registry studies investigating CAP. Data were pooled by means of the random-effects model. In 16 studies involving 197,061 percutaneous coronary interventions, the pooled incidence of CAP was 0.43% (95% confidence interval, 0.35%-0.52%). The most reproducible risk factors were treatment of complex lesions and use of atheroablative devices. A variety of major management strategies for CAP were used, in particular, observation, heparin reversal, prolonged balloon inflation, covered stent implantation, pericardiocentesis, and surgery. In a hierarchical Bayesian random-effects model, the pooled tamponade rates were 0.4% (95% credible interval [CrI], 0.0%-5.7%), 3.3% (95% CrI, 0.0%-11.4%), and 45.7% (95% CrI, 34.9%-57.5%) for patients with Ellis class I, II, and III CAP, respectively. Pooled mortality rates were 0.3% (95% CrI, 0.0%-4.4%), 0.4% (95% CrI, 0.0%-2.8%), and 21.2% (95% CrI, 12.0%-31.4%) for patients with Ellis class I, II, and III CAP respectively. CAP complicating percutaneous coronary intervention is rare, and its morbidity and mortality vary directly with Ellis classification. Management discrepancies highlight the need to establish a uniform treatment paradigm for CAP.
许多研究都探讨了冠状动脉穿孔（CAP）的发生率、预测因素、结局和处理策略。由于样本量有限和/或单中心设计，这些研究单独来看都没有定论。我们对涉及 CAP 的研究进行了系统评价和荟萃分析，以估计其发生率和结局，并批判性地评价其危险因素和处理方法。我们系统地检索了文献，以确定所有调查 CAP 的注册研究。数据采用随机效应模型进行汇总。在涉及 197061 例经皮冠状动脉介入治疗的 16 项研究中，CAP 的总发生率为 0.43%（95%置信区间，0.35%-0.52%）。最可重复的危险因素是治疗复杂病变和使用动脉消融装置。CAP 有多种主要的处理策略，特别是观察、肝素逆转、延长球囊扩张、植入带膜支架、心包穿刺和手术。在分层贝叶斯随机效应模型中，Ellis 分类 I、II 和 III 型 CAP 患者的填塞率分别为 0.4%（95%可信区间，0.0%-5.7%）、3.3%（95%可信区间，0.0%-11.4%）和 45.7%（95%可信区间，34.9%-57.5%）。总死亡率分别为 0.3%（95%可信区间，0.0%-4.4%）、0.4%（95%可信区间，0.0%-2.8%）和 21.2%（95%可信区间，12.0%-31.4%）。经皮冠状动脉介入治疗并发 CAP 较为罕见，其发病率和死亡率与 Ellis 分类直接相关。处理方法的差异突出表明需要为 CAP 建立一个统一的治疗模式。
