From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., N.O.-G., R.A.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care and Health Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); Farr Institute, University of Manchester, United Kingdom (E.K., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); and Department of Cardiology, The James Cook University Hospital, Middlesborough, United Kingdom (M.d.B.).
Circ Cardiovasc Interv. 2016 Aug;9(8). doi: 10.1161/CIRCINTERVENTIONS.115.003449.
As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database, the incidence, predictors, and outcomes of CP as a complication of PCI were defined.
Data were prospectively collected and retrospectively analyzed from the British Cardiovascular Intervention Society data set on all PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. In total, 1762 CPs were recorded from 527 121 PCI procedures (incidence of 0.33%). Patients with CP were more often women or older, with a greater burden of comorbidity and underwent more complex PCI procedures. Factors predictive of CP included age per year (odds ratio [OR], 1.03; 95% confidence intervals, 1.02-1.03; P<0.001), previous coronary artery bypass graft (OR, 1.44; 95% confidence intervals, 1.17-1.77; P<0.001), left main (OR, 1.54; 95% confidence intervals, 1.21-1.96; P<0.001), use of rotational atherectomy (OR, 2.37; 95% confidence intervals, 1.80-3.11; P<0.001), and chronic total occlusions intervention (OR, 3.96; 95% confidence intervals, 3.28-4.78; P<0.001). Adjusted odds of adverse outcomes were higher in patients with CP for all major adverse coronary events, including stroke, bleeding, and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes mellitus, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use, and stent type.
Using a national PCI database for the first time, the incidence, predictors, and outcomes of CP were defined. Although CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes.
冠状动脉穿孔（CP）是经皮冠状动脉介入治疗（PCI）的一种罕见但严重的并发症，目前的证据基础仅限于小系列研究。本研究使用全国性的 PCI 数据库，定义了 CP 作为 PCI 并发症的发生率、预测因素和结局。
数据来自 2006 年至 2013 年期间英格兰和威尔士进行的所有 PCI 程序的英国心血管介入学会数据集中前瞻性收集和回顾性分析。多变量逻辑回归和倾向评分用于确定 CP 的预测因素及其与结局的关联。总共从 527121 例 PCI 中记录到 1762 例 CP（发生率为 0.33%）。CP 患者更多为女性或年龄较大，合并症负担较重，且接受了更复杂的 PCI 程序。CP 的预测因素包括年龄每增加 1 岁（优势比[OR]，1.03；95%置信区间，1.02-1.03；P<0.001）、先前的冠状动脉旁路移植术（OR，1.44；95%置信区间，1.17-1.77；P<0.001）、左主干病变（OR，1.54；95%置信区间，1.21-1.96；P<0.001）、使用旋磨术（OR，2.37；95%置信区间，1.80-3.11；P<0.001）和慢性完全闭塞病变的介入治疗（OR，3.96；95%置信区间，3.28-4.78；P<0.001）。CP 患者发生主要不良心血管事件（包括中风、出血和死亡）的不良结局的调整比值比更高。3%的病例需要紧急手术。CP 患者的死亡预测因素包括年龄、糖尿病、既往心肌梗死、肾脏疾病、通气支持、循环支持使用、糖蛋白抑制剂使用和支架类型。
本研究首次使用全国性的 PCI 数据库定义了 CP 的发生率、预测因素和结局。尽管 CP 作为 PCI 的并发症很少见，但它与不良结局密切相关。
