From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (T.W.J.); Department of Biostatistics, Biosensors SA, Morges, Switzerland (S.C.); Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.Z.); Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.Z.); Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Staffordshire, United Kingdom (M.A.M.); and Department of Cardiology, Stoke-on-Trent and Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M.).
Circ Cardiovasc Interv. 2017 Sep;10(9). doi: 10.1161/CIRCINTERVENTIONS.117.005581.
The evidence base for coronary perforation (CP) occurring during percutaneous coronary intervention in patients with a history of coronary artery bypass surgery (PCI-CABG) is limited and the long-term effects unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during PCI-CABG were defined.
Data were analyzed on all PCI-CABG procedures performed in England and Wales between 2005 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. During the study period, 309 CPs were recorded during 59 644 PCI-CABG procedures with the incidence rising from 0.32% in 2005 to 0.68% in 2013 (<0.001 for trend). Independent associates of perforation in native vessels included age, chronic occlusive disease intervention, rotational atherectomy use, number of stents, hypertension, and female sex. In graft PCI, predictors of perforation were history of stroke, New York Heart Association class, and number of stents used. In-hospital clinical complications including Q-wave myocardial infarction (2.9% versus 0.2%; <0.001), major bleeding (14.0% versus 0.9%; <0.001), blood transfusion (3.7% versus 0.2%; <0.001), and death (10.0% versus 1.1%; <0.001) were more frequent in patients with CP. A continued excess mortality occurred after perforation, with an odds ratio for 12-month mortality of 1.35 for perforation survivors compared with matched nonperforation survivors without a CP (<0.0001).
CP is an infrequent event during PCI-CABG but is closely associated with adverse clinical outcomes. A legacy effect of perforation on 12-month mortality was observed.
在有冠状动脉旁路移植术（PCI-CABG）史的患者中经皮冠状动脉介入治疗（PCI）中发生冠状动脉穿孔（CP）的证据有限，其长期影响尚不清楚。本研究利用全国性的 PCI 数据库，定义了 PCI-CABG 期间 CP 的发生率、预测因素和结局。
对 2005 年至 2013 年期间在英格兰和威尔士进行的所有 PCI-CABG 手术进行了数据分析。多变量逻辑回归和倾向评分用于识别 CP 的预测因素及其与结局的关系。在研究期间，在 59644 例 PCI-CABG 手术中记录了 309 例 CP，其发生率从 2005 年的 0.32%上升至 2013 年的 0.68%（趋势 P<0.001）。在原发性血管中穿孔的独立预测因素包括年龄、慢性闭塞性疾病介入治疗、旋切术使用、支架数量、高血压和女性。在移植血管 PCI 中，穿孔的预测因素包括中风史、纽约心脏协会（NYHA）心功能分级和使用的支架数量。院内临床并发症包括 Q 波心肌梗死（2.9%比 0.2%；P<0.001）、大出血（14.0%比 0.9%；P<0.001）、输血（3.7%比 0.2%；P<0.001）和死亡（10.0%比 1.1%；P<0.001）在 CP 患者中更为常见。穿孔后仍存在持续的超额死亡率，穿孔幸存者与无 CP 的匹配非穿孔幸存者相比，12 个月死亡率的优势比为 1.35（P<0.0001）。
CP 是 PCI-CABG 中一种罕见的事件，但与不良临床结局密切相关。观察到穿孔对 12 个月死亡率的遗留影响。
