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19 An analysis of 59,644 PCI cases in patients with previous CABG: is there a legacy effect of coronary perforation?
  1. Tim Kinnaird1,
  2. Richard Anderson1,
  3. Nicholas Ossei-Gerning1,
  4. James Cockburn2,
  5. Alex Sirker3,
  6. Peter Ludman4,
  7. Mark deBelder5,
  8. Tom Johnson6,
  9. Andreas Baumbach6,
  10. Samuel Copt7,
  11. Azfar Zaman8,
  12. Mamas A Mamas9,
  13. on behalf of the British Cardiovascular Intervention Society, The National Institute for Cardiovascular Outcomes Research
  1. 1Department of Cardiology, University Hospital of Wales, Cardiff, UK
  2. 2Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
  3. 3Department of Cardiology, University College Hospital, London, UK
  4. 4Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
  5. 5Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
  6. 6Department of Cardiology, Bristol Royal Infirmary, Bristol, UK
  7. 7Biosensors SA, Morges, Switzerland
  8. 8Department of Cardiology, Freeman Hospital, Newcastle
  9. 9Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent

Abstract

Background The evidence base for coronary perforation (CP) occurring during PCI in patients with a history of bypass surgery (PCI-CABG) is limited and the long-term effects unclear.

Methods Data analysed from the BCIS dataset on all PCI-CABG procedures performed between 2005 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes.

Results 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 were age (odds ratio (OR) 95% confidence intervals 1.03 [1.02–1.05], p<0.001), female gender (OR 1.74 [1.21–2.49], p=0.002), hypertension (OR 1.83 [1.25–2.69], p<0.001), chronic occlusive disease (OR1.89 [1.23–2.64], p<0.001) and rotational atherectomy use (OR 2.44 [1.42–4.17], p=0.002). 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 legacy effect of perforation on mortality was evident, 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 has a significant impact on in-hospital clinical events. A legacy effect of perforation on 12 month mortality was observed.

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