Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2019 Jan 1;93(1):48-56. doi: 10.1002/ccd.27706. Epub 2018 Oct 12.
We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation.
Coronary perforation is a rare, but important, complication of percutaneous coronary intervention (PCI). There is lack of data on perforations stratified as large and distal vessel perforations.
Retrospective, observational cohort study of all patients who underwent PCI at a high volume, tertiary hospital between the years 2009 and 2016. Angiograms of all coronary perforation cases were reviewed to determine the mechanism, type, and management of perforation. Risk-adjusted periprocedural complication rates were compared between patients with and without coronary perforation. One-year mortality outcomes of patients with large vessel vs. distal vessel perforation were also examined.
Coronary perforation occurred in 68 of 13,339 PCIs (0.51%) performed during the study period: 51 (75%) were large vessel perforations and 17 (25%) distal vessel perforations. Most (67%) large vessel perforations were due to balloon/stent inflation, whereas most (94%) distal vessel perforations were due to guidewire exit. Patients with coronary perforations had significantly higher risk for periprocedural complications (adjusted odds ratio 7.57; 95% CI: 4.22-13.50; P < 0.001). Only one patient with large vessel perforation required emergency cardiac surgery, yet in-hospital mortality was high with both large vessel (7.8%) and distal vessel (11.8%) perforations.
Coronary perforation is an infrequent, but potentially severe PCI complication. Most coronary perforations are large vessel perforations. Although coronary perforations rarely lead to emergency cardiac surgery, both distal vessel and large vessel perforations are associated with high in-hospital mortality, highlighting the importance of prevention.
我们研究了当代经皮冠状动脉介入治疗（PCI）后冠状动脉穿孔的发生率、类型、预测因素、血管造影特征、处理方法和结果。
冠状动脉穿孔是经皮冠状动脉介入治疗（PCI）后一种罕见但重要的并发症。缺乏关于大血管穿孔和远端血管穿孔的分层穿孔数据。
回顾性观察性队列研究，纳入 2009 年至 2016 年在一家高容量三级医院行 PCI 的所有患者。回顾所有冠状动脉穿孔病例的血管造影，以确定穿孔的机制、类型和处理方法。比较穿孔患者与非穿孔患者的围手术期并发症发生率。还检查了大血管穿孔和远端血管穿孔患者的一年死亡率。
在研究期间，13339 例 PCI 中有 68 例（0.51%）发生冠状动脉穿孔：51 例（75%）为大血管穿孔，17 例（25%）为远端血管穿孔。大多数（67%）大血管穿孔是由于球囊/支架扩张所致，而大多数（94%）远端血管穿孔是由于导丝退出所致。发生冠状动脉穿孔的患者围手术期并发症风险显著升高（调整后优势比 7.57；95%可信区间：4.22-13.50；P<0.001）。仅有 1 例大血管穿孔患者需要紧急心脏手术，但大血管穿孔（7.8%）和远端血管穿孔（11.8%）的院内死亡率均较高。
冠状动脉穿孔是一种罕见但潜在严重的 PCI 并发症。大多数冠状动脉穿孔为大血管穿孔。虽然冠状动脉穿孔很少导致紧急心脏手术，但大血管穿孔和远端血管穿孔均与较高的院内死亡率相关，强调了预防的重要性。
