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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2018 Feb 01

DOI: 10.23736/S0026-4725.18.04433-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Temporal trends in frequency, management and outcomes of coronary perforations

Agustín FERNÁNDEZ-CISNAL, Rafael ROMAGUERA , Marcos ÑATO, Josep GÓMEZ-LARA, José L. FERREIRO, Luis TERUEL, Gerard ROURA, Guillem MUNTANÉ-CAROL, José GONZÁLEZ-COSTELLO, Francisco JACOBI, Montserrat GRACIDA, Joan A. GÓMEZ-HOSPITAL, Ángel CEQUIER

Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain


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BACKGROUND: Coronary perforations (CP) have been described as a rare but potentially fatal complication in percutaneous coronary interventions (PCI). Our aim is to compare temporal trends in frequency, management and outcomes of coronary perforations (CP).
METHODS: All cases of CP recorded in our prospective institutional percutaneous coronary intervention (PCI) registry from 2003 to 2015 were included. Patients were divided in 2 groups according to the time frame in which the CP occurred: the early period (before 2009, when the chronic total occlusions and primary PCI programs started) and the current period. The primary endpoint was the composite of in-hospital serious adverse events, including final TIMI flow 0- 1, cardiac tamponade, emergent cardiac surgery or death.
RESULTS: Overall, 88 CP occurred in 17,566 procedures (0.50%). Of these, 17(0.26%) occurred during the early period and 71(0.64%) during the current period (p<0.001). CP management differed between groups, with less CP sealed by intracoronary devices in the early period than in the current one (23.5% vs 47.9%, p=0.068). Moreover, patients with CP during the early period experienced more in-hospital serious adverse events (69% vs 31% respectively, OR 3.18, 95%CI 1.07-9.45, p=0.037).
CONCLUSIONS: Expansion of indications and complexity of PCI in the current era may be associated with an increased frequency of CP. However, progress in technical and device management of CP have led to an improvement in the prognosis of this feared complication.


KEY WORDS: Percutaneous coronary intervention - Perforation - Chronic total occlusion

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Publication History

Article first published online: February 01, 2018
Manuscript accepted: January 29, 2018
Manuscript revised: November 13, 2017
Manuscript received: May 15, 2017

Cite this article as

Fernández-Cisnal A, Romaguera R, Ñato M, Gómez-Lara J, Ferreiro JL, Teruel L, et al. Temporal trends in frequency, management and outcomes of coronary perforations. Minerva Cardioangiol 2018 Feb 01. DOI: 10.23736/S0026-4725.18.04433-X

Corresponding author e-mail

rafaromaguera@gmail.com