Coronary Artery Perforation During Percutaneous Coronary Intervention: Risk Factors And Management

Background：Currently as the increasing number of PCI in treating coronaryheart disease, the coronary arterial perforation (CAP) were increasing year byyear.As a rare but serious complication of PCI, interventional doctors paymoreattention to it. The studies show that CAP is caused by a variety of factors. Butpresent，most domestic studies were sporadic reported cases, international studiesresulted contradiction.Treatments lack uniform standards. This retrospectivestudy attempts accumulate more theoretical support for the prevention andtreatment of coronary artery perforation.Objective:Study incidence, probably influence factors and management ofcoronary artery perforation (CAP) in PCI patients.Methods:This research involved a total of11853cases including8356malesand3497females during percutaneous coronary intervention in the First Hospitalof JiLin University, center of cardiovascular disease fromJanuary2011to January2015. This research involved a total of41cases including24males and16females were definitely diagnosed as coronary artery perforation. And105casesas normal group randomized from11812cases left. The clinical data, PCI dataand management were collected and compared to analyze the differences.Result:①The total incidence was0.35%，The overall mortality rate of CAPis4.88%.②Univariate analysis showed that age（P=0.007）,lesion class B2+C（P＜0.001）,heavy calcifiedlesion（P=0.005）,chronic total occlusion（P＜0.001）,small vessels（P=0.011）,triple-vessel disease（P=0.003）and leftanterior descending（P=0.023）were related to CAP（P＜0.05）. Furthermore,multiple Logistic regression analysis indicated that increasing age（OR1.05；95%CI1.002-1.101）,heavy calcifiedlesion（OR3.08；95%CI1.252-7.558）,chronic total occlusion（OR2.80；95%CI1.083-7.225）and left anteriordescending（OR2.56；95%CI1.098-5.946）were independent risk factors of coronary artery perforation.③Vessels were perforated by balloons (43.91%),wires (41.46%).④Prolonged balloon inflation, embolism, covered stent,pericardiocentesis, autotransfusion and CABG were effective treatments forcoronary artery perforation.Conclusion:①Coronary artery perforations as a incidence of complicationsof PCI is rare.②Differences of those fellow factors had statistical significancebetween CAP group and normal group, which including age,lesion class B2+C,heavy calcifiedlesion,chronic total occlusion,small vessels, triple-vessel diseaseand left anterior descending.③Increasing age,heavy calcifiedlesion,chronic totalocclusion and left anterior descendingwere independent risk factors of CAP.④Prolonged balloon inflation, embolism, covered stent,pericardiocentesis,autotransfusion and CABG were effective treatments forcoronary artery perforation.