Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Barbara Anna Danek, Aris Karatasakis, Peter Tajti, Yader Sandoval, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc Jaffer, Robert W. Yeh, David E. Kandzari, Nicholas J. Lembo, Mitul P. Patel, Ehtisham Mahmud, James W. Choi, Anthony H. Doing, William L. Lombardi, R. Michael Wyman, Catalin Toma, Santiago Garcia, Jeffrey W. Moses, Ajay J. KirtaneRaja Hatem, Ziad A. Ali, Manish Parikh, Judit Karacsonyi, Bavana V. Rangan, Houman Khalili, M. Nicholas Burke, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

18 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1285-1292
Number of pages8
JournalAmerican Journal of Cardiology
Volume120
Issue number8
DOIs
StatePublished - Oct 15 2017

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Percutaneous Coronary Intervention
Incidence
Pericardiocentesis
Coronary Artery Bypass
Transplants
Registries
Dissection
Coronary Vessels
Japan
Odds Ratio
Confidence Intervals

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Danek, B. A., Karatasakis, A., Tajti, P., Sandoval, Y., Karmpaliotis, D., Alaswad, K., ... Brilakis, E. S. (2017). Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention. American Journal of Cardiology, 120(8), 1285-1292. https://doi.org/10.1016/j.amjcard.2017.07.010

Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention. / 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.

In: American Journal of Cardiology, Vol. 120, No. 8, 15.10.2017, p. 1285-1292.

Research output: Contribution to journalArticle

Danek, BA, Karatasakis, A, Tajti, P, Sandoval, Y, Karmpaliotis, D, Alaswad, K, Jaffer, F, Yeh, RW, Kandzari, DE, Lembo, NJ, Patel, MP, Mahmud, E, Choi, JW, Doing, AH, Lombardi, WL, Wyman, RM, Toma, C, Garcia, S, Moses, JW, Kirtane, AJ, Hatem, R, Ali, ZA, Parikh, M, Karacsonyi, J, Rangan, BV, Khalili, H, Burke, MN, Banerjee, S & Brilakis, ES 2017, 'Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention', American Journal of Cardiology, vol. 120, no. 8, pp. 1285-1292. https://doi.org/10.1016/j.amjcard.2017.07.010
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. / Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention. In: American Journal of Cardiology. 2017 ; Vol. 120, No. 8. pp. 1285-1292.
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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.",
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T1 - Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

AU - Danek, Barbara Anna

AU - Karatasakis, Aris

AU - Tajti, Peter

AU - Sandoval, Yader

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Jaffer, Farouc

AU - Yeh, Robert W.

AU - Kandzari, David E.

AU - Lembo, Nicholas J.

AU - Patel, Mitul P.

AU - Mahmud, Ehtisham

AU - Choi, James W.

AU - Doing, Anthony H.

AU - Lombardi, William L.

AU - Wyman, R. Michael

AU - Toma, Catalin

AU - Garcia, Santiago

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay J.

AU - Hatem, Raja

AU - Ali, Ziad A.

AU - Parikh, Manish

AU - Karacsonyi, Judit

AU - Rangan, Bavana V.

AU - Khalili, Houman

AU - Burke, M. Nicholas

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2017/10/15

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N2 - 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.

AB - 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.

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