Keele Research Repository

Background: As coronary perforation (CP) is a rare but serious complication of percutaneous coronary intervention (PCI) the current evidence base is limited to small series. Using a national PCI database the incidence, predictors and outcomes of CP as a complication of PCI were defined. Methods and Results: Data were prospectively collected and retrospectively analysed from the British Cardiovascular Intervention Society dataset on all PCI procedures performed in England and Wales between 2006 and 2013. Multivariable logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. In total 1,762 coronary perforations were recorded from 527,121 PCI procedures (incidence of 0.33%). Patients with CP were more often female or older, with a greater burden of co-morbidity and underwent more complex PCI procedures. Factors predictive of CP included age per year (odds ratio (OR) 1.03, 95% CI 1.02-1.03, p<0.001), previous CABG (OR 1.44, 1.17-1.77, p<0.001), left main (OR 1.54, 1.21-1.96, p<0.001) use of rotational atherectomy (OR 2.37, 1.80-3.11, p<0.001) and CTO intervention (OR 3.96, 3.28-4.78, p<0.001). Adjusted odds of adverse outcomes were higher for all major adverse coronary events including stroke, bleeding and mortality. Emergency surgery was required in 3% of cases. Predictors of mortality in patients with CP included age, diabetes, previous myocardial infarction, renal disease, ventilatory support, use of circulatory support, glycoprotein inhibitor use and stent type. Conclusions: Using a national PCI database for the first time the incidence, predictors and outcomes of coronary perforation were defined. Although CP as a complication of PCI occurred rarely, it was strongly associated with poor outcomes.