Coronary perforation complicating percutaneous coronary intervention in patients presenting with an acute coronary syndrome: An analysis of 1013 perforation cases from the British Cardiovascular Intervention Society database

Kinnaird, Tim; Kwok, Chun Shing; Davies, Rhodri; Calvert, Patrick A.; Anderson, Richard; Gallagher, Sean; Sirker, Alex; Ludman, Peter; deBelder, Mark; Stables, Rod; Johnson, Thomas W.; Kontopantelis, Evan; Curzen, Nick; Mamas, Mamas

Abstract

Background
The evidence base for coronary perforation occurring during percutaneous coronary intervention in patients presenting with an acute coronary syndrome (ACS-PCI) is limited and the specific role of acute pharmacology in its clinical presentation unclear.

Methods and results
Using the BCIS PCI database, data were analysed on all ACS-PCI procedures performed in England and Wales between 2007 and 2014. Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes. Propensity score matching was used to evaluate the association between differing P2Y12 inhibitors or glycoprotein inhibitors (GPI) and CP. During 270,329 ACS-PCI procedures, 1013 coronary perforations were recorded (0.37%) with a stable annual incidence. In multiple regression analysis, covariates associated with increased frequency of coronary perforation included age, female gender, CTO intervention, number and length of stents used, and rotational atherectomy use, whilst differing P2Y12 inhibitors were not predictive. Using propensity score matching, use of a GPI was independently associated with tamponade (OR 1.50, [1.08–2.06], p = 0.014). The adjusted odds ratios for all clinical outcomes were adversely affected by coronary perforation.

Conclusions
Coronary perforation is an infrequent event during ACS-PCI but is closely associated with adverse clinical outcomes. GPI use was associated with higher rates of tamponade.

Citation

Kinnaird, T., Kwok, C. S., Davies, R., Calvert, P. A., Anderson, R., Gallagher, S., …Mamas, M. (2020). Coronary perforation complicating percutaneous coronary intervention in patients presenting with an acute coronary syndrome: An analysis of 1013 perforation cases from the British Cardiovascular Intervention Society database. International Journal of Cardiology, 299, 37-42. https://doi.org/10.1016/j.ijcard.2019.06.034

• Journal Article Type: Article
• Acceptance Date: Jun 12, 2019
• Online Publication Date: Jun 14, 2019
• Publication Date: Jan 15, 2020
• Deposit Date: Jun 21, 2023
• Journal: International Journal of Cardiology
• Print ISSN: 0167-5273
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 299
• Pages: 37-42
• DOI: https://doi.org/10.1016/j.ijcard.2019.06.034
• Keywords: Cardiology and Cardiovascular Medicine; Coronary perforation; Acute coronary syndrome; Percutaneous coronary intervention; Tamponade; Anti-platelet therapy; Glycoprotein inhibition
• Additional Information: This article is maintained by: Elsevier; Article Title: Coronary perforation complicating percutaneous coronary intervention in patients presenting with an acute coronary syndrome: An analysis of 1013 perforation cases from the British Cardiovascular Intervention Society database; Journal Title: International Journal of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.ijcard.2019.06.034; Content Type: article; Copyright: © 2019 Elsevier B.V. All rights reserved.