Matsuura Hirohide, Mukai Yasushi, Honda Yasuhiro, Nishino Shun, Kang Honsa, Kadooka Kosuke, Ogata Kenji, Kimura Toshiyuki, Koiwaya Hiroshi, Nishihira Kensaku, Kuriyama Nehiro, Shibata Yoshisato
Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center Miyazaki Japan.
Department of Cardiology, Japanese Red Cross Fukuoka Hospital Fukuoka Japan.
Circ Rep. 2022 Oct 13;4(11):517-525. doi: 10.1253/circrep.CR-22-0092. eCollection 2022 Nov 10.
Little is known regarding the postprocedural management of coronary artery perforation (CAP). The characteristics, outcomes, and management of 115 CAP cases among 13,453 patients undergoing percutaneous coronary intervention (PCI) between 2001 and 2017 at Miyazaki Medical Association Hospital were analyzed retrospectively. The incidence of CAP was 0.85% (25 [0.19%] coronary ruptures [CRs], 90 [0.67%] wire perforations [WPs]). The most prevalent causes of CRs and WPs were rotational atherectomy (36.0%) and polymer-jacketed wires (41.1%), respectively. Fifty-two percent of CRs were treated using prolonged balloon inflation, whereas 50% of WPs were treated through embolization. Immediate and delayed cardiac tamponade (CT) occurred in 20% and 24% of CRs, respectively, and in 2.2% and 10% of WPs, respectively. The mean (±SD) right atrial pressure (RAP) during delayed CT in the CR and WP groups was 16.0±1.2 and 14.0±3.0 mmHg, respectively. New-onset atrial fibrillation developed in 24.0% and 11.1% of patients in the CR and WP groups, respectively, whereas late-onset coronary artery aneurysm (CAA) occurred in 24.0% and 0% of patients, respectively. One-year mortality rates in patients with immediate and delayed CT were 28.6% and 20.0%, respectively. Special attention should be paid to delayed CT, new-onset atrial fibrillation, and late-onset CAA after CAP treatment. Continuous monitoring of RAP after CAP during PCI may be useful for the early detection of delayed CT.
关于冠状动脉穿孔（CAP）的术后管理，目前所知甚少。对2001年至2017年间在宫崎医学协会医院接受经皮冠状动脉介入治疗（PCI）的13453例患者中的115例CAP病例的特征、结局及管理进行了回顾性分析。CAP的发生率为0.85%（25例[0.19%]冠状动脉破裂[CRs]，90例[0.67%]导丝穿孔[WPs]）。CRs和WPs最常见的原因分别是旋磨术（36.0%）和带聚合物涂层的导丝（41.1%）。52%的CRs采用延长球囊扩张治疗，而50%的WPs通过栓塞治疗。CRs分别有20%和24%发生即刻和延迟心脏压塞（CT），WPs分别有2.2%和10%发生。CR组和WP组延迟CT期间的平均（±标准差）右心房压力（RAP）分别为16.0±1.2和14.0±3.0 mmHg。CR组和WP组分别有24.0%和11.1%的患者发生新发房颤，而分别有24.0%和0%的患者发生迟发性冠状动脉瘤（CAA）。发生即刻和延迟CT的患者的1年死亡率分别为28.6%和20.0%。CAP治疗后应特别关注延迟CT、新发房颤和迟发性CAA。PCI期间CAP后持续监测RAP可能有助于早期发现延迟CT。
