2010 年至 2020 年间经皮冠状动脉介入治疗中心肌梗死穿孔的多中心经验：临床和血管造影特征、处理和结局。
Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020.
机构信息
Department of Cardiology, Manisa City Hospital, Manisa, Turkey.
Department of Cardiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
出版信息
Anatol J Cardiol. 2022 Aug;26(8):608-618. doi: 10.5152/AnatolJCardiol.2022.1337.
BACKGROUND
Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey.
METHODS
The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients.
RESULTS
The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%.
CONCLUSION
The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.
背景
冠状动脉穿孔是经皮冠状动脉介入治疗中最可怕、最罕见和最具灾难性的并发症之一。尽管冠状动脉造影和经皮冠状动脉介入治疗显著增加，但土耳其人群中没有收集冠状动脉穿孔的大型数据库。我们的研究旨在报告我们在土耳其不同心脏病学部门进行的 10 年期间，经皮冠状动脉介入治疗中冠状动脉穿孔的临床和血管造影特征、管理策略和结果。
方法
该研究数据来自 2010 年 1 月至 2020 年 6 月期间进行的 48360 例经皮冠状动脉介入治疗的回顾性分析。通过血管造影复查发现，共有 110 例患者在经皮冠状动脉介入治疗过程中发生冠状动脉穿孔。对所有患者的基本临床、血管造影、手术特征、冠状动脉穿孔的处理以及结果进行了分析。
结果
冠状动脉穿孔率为 0.22%。在 110 例冠状动脉穿孔患者中，66 例患者因急性冠状动脉综合征而行经皮冠状动脉介入治疗，44 例患者因稳定型心绞痛而行经皮冠状动脉介入治疗。最常见的病变类型和穿孔动脉分别为 C 型（34.5%）和左前降支（41.8%）。根据 Ellis 分类，最常见的冠状动脉穿孔类型为 III 型（37.2%）。几乎 52.7%的患者在穿孔动脉中植入了覆盖支架。冠状动脉穿孔患者住院期间的全因死亡率为 18.1%。
结论
我们的研究中观察到的冠状动脉穿孔发生率与该文献中的研究一致。然而，与该文献中的其他研究相比，与冠状动脉穿孔相关的死亡率更高。特别是由于穿孔及其并发症，II 型和 III 型组的住院死亡率更高。尽管存在灾难性并发症，仍应在选择的患者中进行经皮冠状动脉介入治疗。
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