West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK.
British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK.
J Am Heart Assoc. 2022 Oct 4;11(19):e024492. doi: 10.1161/JAHA.121.024492. Epub 2022 Sep 21.
Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (=0.73; <0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), <0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; <0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; =0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Clinicaltrials.gov. Identifier: NCT03862352.
GNOCCI（格拉斯哥自然史覆盖支架冠状动脉介入研究）研究的目的是报告在一家高容量经皮冠状动脉介入治疗中心 18 年间冠状动脉穿孔的发生率和结果。我们考虑了覆盖支架植入的时间趋势和长期结果。
我们评估了 43343 例连续经皮冠状动脉介入治疗后冠状动脉穿孔的程序和长期临床结果。程序主要不良心脏事件定义为 24 小时内死亡、心肌梗死、卒、靶血管血运重建或心脏手术的复合终点。共有 161 例（0.37%）手术出现冠状动脉穿孔，其中 57 例（35%）为 Ellis Ⅲ级。在研究期间，发病率随时间增加（=0.73；<0.001）。穿孔严重程度与程序死亡率呈线性相关（中位 2.9 年随访）：Ellis I（0%）、Ellis II（1.7%）、Ellis III/IIIB（21%），<0.001。Ellis III/IIIB 穿孔患者中 47%发生程序主要不良心脏事件，而 Ellis I/II 穿孔患者中为 13.5%（比值比，5.8；95%置信区间，2.7-12.5；<0.001）。在 2.9 年随访时，覆盖支架与支架血栓形成风险增加相关（学术研究联合会确定或可能；9.1%比 0.9%；风险比，10.5；95%置信区间，1.1-97；=0.04）。
2001 年至 2019 年期间，冠状动脉穿孔的发生率增加。严重穿孔与较高的程序主要不良心脏事件相关，是长期死亡率的独立预测因素。尽管覆盖支架是一种潜在的救生治疗方法，但在研究期间使用的器械因疗效和支架血栓形成风险高而受到限制。
Clinicaltrials.gov。标识符：NCT03862352。
