Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Am J Cardiol. 2019 Oct 15;124(8):1186-1189. doi: 10.1016/j.amjcard.2019.07.021. Epub 2019 Jul 25.
Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). With a growing number of PCIs in complex lesions, the problem of CAP becomes even more important nowadays. Data on CAP rates in Poland are lacking. Presented study is an analysis of 344,517 consecutive patients treated with PCI between 2014 and 2017. Data were gathered from the Polish National PCI Registry (ORPKI). During 4 years of data collection CAP was observed in 595 (0.17%) cases. Patients diagnosed with CAP were older (69 years Q1:63; Q3:78 vs 66 years Q1:60; Q3:75; p <0.001), more often female (44% vs 32%; p <0.001), with arterial hypertension (77% vs 71%; p = 0.002), and chronic kidney disease (8.9% vs 5.4%; p <0.001). In the CAP group, a higher rate of PCIs within chronic total occlusions (8.7% vs 2.3%; p <0.001) and saphenous vein graft lesions (2.7% vs 1.3%; p = 0.002), as well as rotational atherectomy procedures (2.2% vs 0.4%; p <0.001) was observed. Patients with CAP had higher rate of no-reflow phenomenon (5.5% vs 0.5%; p <0.001) and greater periprocedural mortality (4.2% vs 0.5%; p <0.001). In conclusion, our study confirms that CAP is more common during complex PCI procedures in high-risk patients. CAP occurrence is associated with worse immediate outcomes including increased periprocedural mortality.
冠状动脉穿孔（CAP）是经皮冠状动脉介入治疗（PCI）的一种罕见但潜在危及生命的并发症。随着复杂病变 PCI 的数量不断增加，CAP 的问题变得更加重要。目前波兰缺乏有关 CAP 发生率的数据。本研究分析了 2014 年至 2017 年期间接受 PCI 治疗的 344517 例连续患者的数据。数据来自波兰国家 PCI 登记处（ORPKI）。在 4 年的数据收集期间，有 595 例（0.17%）患者发生 CAP。诊断为 CAP 的患者年龄较大（69 岁 Q1：63；Q3：78 与 66 岁 Q1：60；Q3：75；p<0.001），女性更多（44%与 32%；p<0.001），高血压（77%与 71%；p=0.002）和慢性肾脏病（8.9%与 5.4%；p<0.001）更为常见。在 CAP 组中，慢性完全闭塞（8.7%与 2.3%；p<0.001）和大隐静脉桥病变（2.7%与 1.3%；p=0.002）以及旋磨术的 PCI 比例较高。CAP 患者无复流现象（5.5%与 0.5%；p<0.001）和围手术期死亡率（4.2%与 0.5%；p<0.001）更高。总之，我们的研究证实，CAP 在高危患者的复杂 PCI 中更为常见。CAP 的发生与更差的即刻结果相关，包括围手术期死亡率增加。
