Keele Research Repository

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.