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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