Background Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited and the long-term effects unclear.
Methods Data analysed from the British Cardiovascular Intervention Society dataset on all CTO-PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes.
Results A total of 376 CP were recorded from 26,807 CTO-PCI interventions (incidence of 1.4%) with an increase in frequency during the study period (p=0.012). Patient-related factors associated with an increased risk of CP were age and female gender. Procedural factors indicative of complex CTO intervention strongly related to an increased risk of CP with a close relationship between the number of complex strategies utilised and CP evident (p=0.008 for trend). Tamponade occurred in 16.6% and emergency surgery in 3.4% of cases. Adverse outcomes were frequent in those patients with perforation including bleeding, transfusion, MI and death. A legacy effect of perforation on mortality was evident, with an odds ratio for 12 month mortality of 1.60 for perforation survivors compared to matched non-perforation survivors without a CP (p<0.0001).
Conclusions Many of the factors associated with an increased risk of CP were related to CTO complexity. Perforation was associated with adverse outcomes, with a legacy effect on later mortality after CP also observed.
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