Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
J Am Heart Assoc. 2017 Sep 22;6(9):e007049. doi: 10.1161/JAHA.117.007049.
Coronary artery perforation (CAP) is a potentially lethal complication of percutaneous coronary intervention. We report on the incidence, clinical characteristics, and management of iatrogenic coronary perforations based on an 11-year single-center experience.
From February 9, 2005, through November 20, 2016, 150 CAP cases were identified from our percutaneous coronary intervention database of 21 212 procedures (0.71%). Mean age of CAP patients was 66±11 years, and 62.7% were male. Treated lesion type was B2/C in 94.6%, and 31.3% were chronic total occlusions. Nonworkhorse guidewires were applied in 74.3%. CAP types were Ellis type I in 2.9%, Ellis type II in 40.4%, Ellis type III in 54.8%, and Ellis type III cavity spilling in 1.9%. CAP treatment was conservative (including prolonged balloon inflation) in 73.3%. Covered stents, coiling, and fat embolization were used in 24.0%, 0.7%, and 2.0%, respectively. Pericardiocentesis for tamponade was required for 72 patients (48.0%), of whom 28 were initially unrecognized. Twelve patients (12.7%) required emergency cardiac surgery to alleviate tamponade. Periprocedural myocardial infarction occurred in 34.0%, and in-hospital all-cause mortality was 8.0%. All-cause mortality accrued to 10.7% at 30 days and 17.8% at 1 year.
CAP is a rare complication of percutaneous coronary intervention, but morbidity and mortality are considerable. Early recognition and adequate management are of paramount importance.
冠状动脉穿孔（CAP）是经皮冠状动脉介入治疗的一种潜在致命并发症。我们报告了基于 11 年单中心经验的医源性冠状动脉穿孔的发生率、临床特征和处理方法。
从 2005 年 2 月 9 日至 2016 年 11 月 20 日，我们从 21212 例经皮冠状动脉介入治疗的数据库中确定了 150 例 CAP 病例（0.71%）。CAP 患者的平均年龄为 66±11 岁，62.7%为男性。治疗病变类型为 B2/C 型占 94.6%，31.3%为慢性完全闭塞。74.3%应用非主力导丝。CAP 类型为 Ellis Ⅰ型占 2.9%，Ellis Ⅱ型占 40.4%，Ellis Ⅲ型占 54.8%，Ellis Ⅲ型腔外溢占 1.9%。73.3%的 CAP 患者采用保守治疗（包括长时间球囊扩张）。24.0%的患者采用覆盖支架、线圈和脂肪栓塞治疗，分别为 0.7%和 2.0%。72 例（48.0%）患者因心包填塞需要心包穿刺，其中 28 例最初未被发现。12 例（12.7%）患者需要紧急心脏手术以缓解填塞。围手术期心肌梗死发生率为 34.0%，住院期间全因死亡率为 8.0%。30 天和 1 年的全因死亡率分别为 10.7%和 17.8%。
CAP 是经皮冠状动脉介入治疗的一种罕见并发症，但发病率和死亡率相当高。早期识别和充分处理至关重要。
