Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention
Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. T...
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| Veröffentlicht in: | The American journal of cardiology 2017-10, Vol.120 (8), p.1285-1292 |
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| creator | Danek, Barbara Anna Karatasakis, Aris Tajti, Peter Sandoval, Yader Karmpaliotis, Dimitri Alaswad, Khaldoon Jaffer, Farouc Yeh, Robert W. Kandzari, David E. Lembo, Nicholas J. Patel, Mitul P. Mahmud, Ehtisham Choi, James W. Doing, Anthony H. Lombardi, William L. Wyman, R. Michael Toma, Catalin Garcia, Santiago Moses, Jeffrey W. Kirtane, Ajay J. Hatem, Raja Ali, Ziad A. Parikh, Manish Karacsonyi, Judit Rangan, Bavana V. Khalili, Houman Burke, M. Nicholas Banerjee, Subhash Brilakis, Emmanouil S. |
| description | Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p |
| doi_str_mv | 10.1016/j.amjcard.2017.07.010 |
| format | Article |
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Michael ; Toma, Catalin ; Garcia, Santiago ; Moses, Jeffrey W. ; Kirtane, Ajay J. ; Hatem, Raja ; Ali, Ziad A. ; Parikh, Manish ; Karacsonyi, Judit ; Rangan, Bavana V. ; Khalili, Houman ; Burke, M. Nicholas ; Banerjee, Subhash ; Brilakis, Emmanouil S.</creator><creatorcontrib>Danek, Barbara Anna ; Karatasakis, Aris ; Tajti, Peter ; Sandoval, Yader ; Karmpaliotis, Dimitri ; Alaswad, Khaldoon ; Jaffer, Farouc ; Yeh, Robert W. ; Kandzari, David E. ; Lembo, Nicholas J. ; Patel, Mitul P. ; Mahmud, Ehtisham ; Choi, James W. ; Doing, Anthony H. ; Lombardi, William L. ; Wyman, R. Michael ; Toma, Catalin ; Garcia, Santiago ; Moses, Jeffrey W. ; Kirtane, Ajay J. ; Hatem, Raja ; Ali, Ziad A. ; Parikh, Manish ; Karacsonyi, Judit ; Rangan, Bavana V. ; Khalili, Houman ; Burke, M. Nicholas ; Banerjee, Subhash ; Brilakis, Emmanouil S.</creatorcontrib><description>Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.07.010</identifier><identifier>PMID: 28826896</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Angioplasty ; Bypasses ; Calcification ; Catheters ; Chronic Disease ; Complexity ; Confidence intervals ; Coronary Angiography ; Coronary artery ; Coronary Occlusion - diagnosis ; Coronary Occlusion - surgery ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - injuries ; Dissection ; Female ; Graft-versus-host reaction ; Heart attacks ; Heart surgery ; Humans ; Incidence ; Intervention ; Intraoperative Complications ; Japan - epidemiology ; Male ; Occlusion ; Odds Ratio ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Perforation ; Registries ; Risk Factors ; Rupture ; Stents ; Success ; Surgery ; Tamponade ; Time Factors ; Treatment Outcome ; United States - epidemiology ; Vascular System Injuries - diagnosis ; Vascular System Injuries - epidemiology ; Vascular System Injuries - therapy ; Veins & arteries</subject><ispartof>The American journal of cardiology, 2017-10, Vol.120 (8), p.1285-1292</ispartof><rights>2017</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Sequoia S.A. Oct 15, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-545fe0e15347fdbaaa44e0b37ed706b117cf74d601b23c687f63b1b58a4332bf3</citedby><cites>FETCH-LOGICAL-c459t-545fe0e15347fdbaaa44e0b37ed706b117cf74d601b23c687f63b1b58a4332bf3</cites><orcidid>0000-0001-7389-7734 ; 0000-0001-9416-9701 ; 0000-0002-5567-1878 ; 0000-0001-9026-9633 ; 0000-0002-5911-1851</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914917311748$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28826896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Danek, Barbara Anna</creatorcontrib><creatorcontrib>Karatasakis, Aris</creatorcontrib><creatorcontrib>Tajti, Peter</creatorcontrib><creatorcontrib>Sandoval, Yader</creatorcontrib><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Alaswad, Khaldoon</creatorcontrib><creatorcontrib>Jaffer, Farouc</creatorcontrib><creatorcontrib>Yeh, Robert W.</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><creatorcontrib>Lembo, Nicholas J.</creatorcontrib><creatorcontrib>Patel, Mitul P.</creatorcontrib><creatorcontrib>Mahmud, Ehtisham</creatorcontrib><creatorcontrib>Choi, James W.</creatorcontrib><creatorcontrib>Doing, Anthony H.</creatorcontrib><creatorcontrib>Lombardi, William L.</creatorcontrib><creatorcontrib>Wyman, R. Michael</creatorcontrib><creatorcontrib>Toma, Catalin</creatorcontrib><creatorcontrib>Garcia, Santiago</creatorcontrib><creatorcontrib>Moses, Jeffrey W.</creatorcontrib><creatorcontrib>Kirtane, Ajay J.</creatorcontrib><creatorcontrib>Hatem, Raja</creatorcontrib><creatorcontrib>Ali, Ziad A.</creatorcontrib><creatorcontrib>Parikh, Manish</creatorcontrib><creatorcontrib>Karacsonyi, Judit</creatorcontrib><creatorcontrib>Rangan, Bavana V.</creatorcontrib><creatorcontrib>Khalili, Houman</creatorcontrib><creatorcontrib>Burke, M. Nicholas</creatorcontrib><creatorcontrib>Banerjee, Subhash</creatorcontrib><creatorcontrib>Brilakis, Emmanouil S.</creatorcontrib><title>Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.</description><subject>Aged</subject><subject>Angioplasty</subject><subject>Bypasses</subject><subject>Calcification</subject><subject>Catheters</subject><subject>Chronic Disease</subject><subject>Complexity</subject><subject>Confidence intervals</subject><subject>Coronary Angiography</subject><subject>Coronary artery</subject><subject>Coronary Occlusion - diagnosis</subject><subject>Coronary Occlusion - surgery</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - injuries</subject><subject>Dissection</subject><subject>Female</subject><subject>Graft-versus-host reaction</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intervention</subject><subject>Intraoperative Complications</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Occlusion</subject><subject>Odds Ratio</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Perforation</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Rupture</subject><subject>Stents</subject><subject>Success</subject><subject>Surgery</subject><subject>Tamponade</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Vascular System Injuries - diagnosis</subject><subject>Vascular System Injuries - epidemiology</subject><subject>Vascular System Injuries - therapy</subject><subject>Veins & arteries</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkVGL1DAQx4N4eOvqR1ACvvhw3cs0adM-iayet3CwPqzPIU2nmtImZ5IeCPfhzbLrCb4IA8Mwv_nPJH9C3gDbAIP6etzoeTQ69JuSgdywHMCekRU0si2gBf6crBhjZdGCaC_JyxjHXAJU9QtyWTZNWTdtvSKPO2dsj87gFT0E1GlGl66odj3dL8n4GSP1A9364J0Ov-hXDIMPOlnv6KclWPedbn_knjX04JOe6N6YaYnHdkbNkrRDv8S_AjuXMDzkJRl5RS4GPUV8fc5r8u3m82F7W9ztv-y2H-8KI6o2FZWoBmQIFRdy6DuttRDIOi6xl6zuAKQZpOhrBl3JTd3IoeYddFWjBedlN_A1eX_SvQ_-54IxqdlGg9N0Ok5By6GsBC_LjL77Bx39Ely-LlOiaiTwLLom1YkywccYcFD3wc75eQqYOtqjRnW2Rx3tUSwHsDz39qy-dDP2T1N__MjAhxOA-TseLAYVjT2609uAJqne2_-s-A188KTM</recordid><startdate>20171015</startdate><enddate>20171015</enddate><creator>Danek, Barbara Anna</creator><creator>Karatasakis, Aris</creator><creator>Tajti, Peter</creator><creator>Sandoval, Yader</creator><creator>Karmpaliotis, Dimitri</creator><creator>Alaswad, Khaldoon</creator><creator>Jaffer, Farouc</creator><creator>Yeh, Robert W.</creator><creator>Kandzari, David E.</creator><creator>Lembo, Nicholas J.</creator><creator>Patel, Mitul P.</creator><creator>Mahmud, Ehtisham</creator><creator>Choi, James W.</creator><creator>Doing, Anthony H.</creator><creator>Lombardi, William L.</creator><creator>Wyman, R. 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Michael ; Toma, Catalin ; Garcia, Santiago ; Moses, Jeffrey W. ; Kirtane, Ajay J. ; Hatem, Raja ; Ali, Ziad A. ; Parikh, Manish ; Karacsonyi, Judit ; Rangan, Bavana V. ; Khalili, Houman ; Burke, M. 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Michael</au><au>Toma, Catalin</au><au>Garcia, Santiago</au><au>Moses, Jeffrey W.</au><au>Kirtane, Ajay J.</au><au>Hatem, Raja</au><au>Ali, Ziad A.</au><au>Parikh, Manish</au><au>Karacsonyi, Judit</au><au>Rangan, Bavana V.</au><au>Khalili, Houman</au><au>Burke, M. Nicholas</au><au>Banerjee, Subhash</au><au>Brilakis, Emmanouil S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-10-15</date><risdate>2017</risdate><volume>120</volume><issue>8</issue><spage>1285</spage><epage>1292</epage><pages>1285-1292</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28826896</pmid><doi>10.1016/j.amjcard.2017.07.010</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7389-7734</orcidid><orcidid>https://orcid.org/0000-0001-9416-9701</orcidid><orcidid>https://orcid.org/0000-0002-5567-1878</orcidid><orcidid>https://orcid.org/0000-0001-9026-9633</orcidid><orcidid>https://orcid.org/0000-0002-5911-1851</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2017-10, Vol.120 (8), p.1285-1292 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1931254322 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aged Angioplasty Bypasses Calcification Catheters Chronic Disease Complexity Confidence intervals Coronary Angiography Coronary artery Coronary Occlusion - diagnosis Coronary Occlusion - surgery Coronary vessels Coronary Vessels - diagnostic imaging Coronary Vessels - injuries Dissection Female Graft-versus-host reaction Heart attacks Heart surgery Humans Incidence Intervention Intraoperative Complications Japan - epidemiology Male Occlusion Odds Ratio Patients Percutaneous Coronary Intervention - adverse effects Perforation Registries Risk Factors Rupture Stents Success Surgery Tamponade Time Factors Treatment Outcome United States - epidemiology Vascular System Injuries - diagnosis Vascular System Injuries - epidemiology Vascular System Injuries - therapy Veins & arteries |
| title | Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T20%3A30%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Incidence,%20Treatment,%20and%20Outcomes%20of%20Coronary%20Perforation%20During%20Chronic%20Total%20Occlusion%20Percutaneous%20Coronary%20Intervention&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Danek,%20Barbara%20Anna&rft.date=2017-10-15&rft.volume=120&rft.issue=8&rft.spage=1285&rft.epage=1292&rft.pages=1285-1292&rft.issn=0002-9149&rft.eissn=1879-1913&rft_id=info:doi/10.1016/j.amjcard.2017.07.010&rft_dat=%3Cproquest_cross%3E1945871343%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1945871343&rft_id=info:pmid/28826896&rft_els_id=S0002914917311748&rfr_iscdi=true |