Kinnaird, T and Anderson, R and Ossei-Gerning, N and Cockburn, J and Sirker, A and Ludman, P and Debelder, M and Copt, S and Johnson, T and Zaman, A and Mamas, M (2015) Coronary perforation complicating percutaneous coronary intervention in patients with a history of coronary artery bypass surgery: an analysis of 309 perforation cases from the British Cardiovascular Intervention Society database. Circulation: Cardiovascular Interventions, 10 (9). ISSN 1941-7632

[img] Text
CABG perforation figures circ int resub.pdf - Supplemental Material
Restricted to Repository staff only until 15 September 2018.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (55kB)
[img] Text
CABG perforation supp tables resubmission.pdf - Supplemental Material
Restricted to Repository staff only until 15 September 2018.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (76kB)
[img] Text
CABG perforation tables Circ Int post review.docx - Supplemental Material
Restricted to Repository staff only until 15 September 2018.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (37kB)
[img] Text
Perforation and CABG for Circ Int 2nd resubmission clean.docx - Accepted Version
Restricted to Repository staff only until 15 September 2018.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (53kB)

Abstract

Background: The evidence base for coronary perforation (CP) occurring during percutaneous coronary intervention in patients with a history of bypass surgery (PCI-CABG) is limited and the long-term effects unclear. Using a national PCI database, the incidence, predictors and outcomes of CP during PCI-CABG were defined.

Methods and Results: Data was analysed on all PCI-CABG procedures performed in England and Wales between 2005 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. During the study period, 309 coronary perforations were recorded during 59,644 PCI-CABG procedures with the incidence rising from 0.32% in 2005 to 0.68% in 2013 (p<0.001 for trend). Independent associates of perforation in native vessels included age, chronic occlusive disease intervention, rotational atherectomy use, number of stents, hypertension and female gender. In graft PCI, predictors of perforation were history of stroke, NYHA class, and number of stents used. In-hospital clinical complications including Q-wave MI (2.9 vs. 0.2%, p<0.001), major bleeding (14.0 vs. 0.9%, p<0.001), blood transfusion (3.7 vs. 0.2%, p<0.001), and death (10.0 vs. 1.1%, p<0.001) were more frequent in patients with coronary perforation. A continued excess mortality occurred after perforation, with an odds ratio for 12-month mortality of 1.35 for perforation survivors compared to matched non-perforation survivors without a CP (p<0.0001).

Conclusions: Coronary perforation is an infrequent event during PCI-CABG but is closely associated with adverse clinical outcomes. A legacy effect of perforation on 12-month mortality was observed.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via American Heart Association at https://doi.org/10.1161/CIRCINTERVENTIONS.117.005581 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Coronary perforation, coronary artery bypass surgery, percutaneous coronary intervention, complications, national database, tamponade
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 09 Aug 2017 15:45
Last Modified: 20 Oct 2017 09:17
URI: http://eprints.keele.ac.uk/id/eprint/3897

Actions (login required)

View Item View Item