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Kinnaird T, Kwok CS, Davies R, Calvert PA, Anderson R, Gallagher S, Sirker A, Ludman P, deBelder M, Stables R, Johnson TW, Kontopantelis E, Curzen N, Mamas M. 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. Int J Cardiol 2019; 299:37-42. [PMID: 31253528 DOI: 10.1016/j.ijcard.2019.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 11/20/2022]
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.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK.
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK; Royal Stoke Hospital, UHNM, Stoke-on-Trent, UK
| | - Rhodri Davies
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Alex Sirker
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Mark deBelder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Rod Stables
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
| | | | - Evan Kontopantelis
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Trust, School of Medicine, University of Southampton, Southampton, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, UK; Royal Stoke Hospital, UHNM, Stoke-on-Trent, UK
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