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22 The legacy effect of coronary perforation complicating PCI-CTO: an analysis of 26,807 cases from the BCIS database
  1. Tim Kinnaird1,
  2. Richard Anderson1,
  3. Nicholas Ossei-Gerning1,
  4. James Cockburn2,
  5. Alex Sirker3,
  6. Peter Ludman4,
  7. Mark de Belder5,
  8. Simon Walsh6,
  9. Colm Hanratty6,
  10. Elliot Smith7,
  11. Julian Strange8,
  12. James Spratt9,
  13. David Hildick-Smith2,
  14. Mamas A Mamas10
  1. 1Department of Cardiology, University Hospital of Wales, Cardiff
  2. 2Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton
  3. 3Department of Cardiology, University College Hospital, London, UK
  4. 4Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham
  5. 5Department of Cardiology, The James Cook University Hospital, Middlesbrough
  6. 6Department of Cardiology, Royal Victoria Hospital, Belfast
  7. 7Department of Cardiology, St Bartholomew’s Hospital, London
  8. 8Department of Cardiology, Bristol Royal Infirmary, Bristol
  9. 9Department of Cardiology, Edinburgh Royal Infirmary, Edinburgh
  10. 10Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent


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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