"Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention"

Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis

Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP).

METHODS

Prospective systematic review and meta-analysis including meta-regression using MEDLINE and EMBASE to November 2020. We included 'all-comer' PCI cohorts including large PCI registries and randomised controlled trials and excluding registries or trials limited to PCI in high-risk populations such as chronic total occlusion PCI or cohorts treated only with atheroablative devices. Regression analysis and corresponding correlation coefficients were performed comparing perforation incidence, mortality rate, tamponade rate and the rate of Ellis III perforations against the midpoint (year) of data collection to determine if a significant temporal relationship was present.

RESULTS

3997 studies were screened for inclusion. 67 studies met eligibility criteria with a total of 5 568 191 PCIs included over a 38-year period (1982-2020). The overall pooled incidence of perforation was 0.39% (95% CI 0.34% to 0.45%) and remained similar throughout the study period. Around 1 in 5 coronary perforations led to tamponade (21.1%). Ellis III perforations are increasing in frequency and account for 43% of all perforations. Perforation mortality has trended lower over the years (7.5%; 95% CI 6.7% to 8.4%). Perforation risk factors derived using meta-regression were female sex, hypertension, chronic kidney disease and previous coronary bypass grafting. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%.

CONCLUSION

Coronary perforation complicates approximately 1 in 250 PCIs. Ellis III perforations are increasing in incidence although it is unclear whether this is due to reporting bias. Despite this, the overall perforation mortality rate (7.5%) has trended lower in recent years. Limitations of our findings include bias that may be introduced through analysis of multidesign studies and registries without pre-specified standardised perforation reporting CMore research into coronary perforation management including the optimal use of covered stents seems warranted.

PROSPERO REGISTRATION NUMBER

CRD42020207881.

Perforation of Right Coronary Artery During Coronary Angioplasty: A Rare Complication

Coronary angioplasty procedure, also known as percutaneous transluminal coronary angioplasty (PTCA), is performed to restore blood flow across significantly blocked coronary vessels. Perforation of coronary vessels may occur rarely during the procedure or within 24 hours post-procedure and is considered a serious complication. We wish to share our experience of a case of perforation in the proximal and mid-portion of the right coronary artery (RCA) during coronary angioplasty. To seal the perforation, the balloon was inflated and vitals were monitored. Check coronary angiography showed persisting extravasation but with no collection on serial echocardiograms. It was confirmed that the perforation was not in the pericardial space but inside the cardiac chamber. The patient was shifted to the cardiac care unit, for further monitoring of vitals and echocardiogram studies for the next 72 hours to ensure recovery. Wire-induced coronary perforations into the cardiac chamber are most of the time benign and are conservatively managed.

Study on the Mechanism of Cardiac Intensive Care after Thoracoscopic Surgery

Objective

To explore the mechanism of intensive care of the heart after thoracoscopic surgery.

Methods

104 patients with severe cardiac disease were selected after thoracoscopic surgery in our hospital, received nursing care after surgery, and divided into control group (n = 53) and research group (n = 51) according to different nursing methods. Before nursing, the research group carried out targeted nursing and prevention of postoperative complications. The quality of life, complications, anxiety, depression and satisfaction scores, 6-minute walking distance, self-care ability scores, and cardiac function were compared between the two groups.

Results

Patients' quality of life scores improved significantly in both groups after treatment, but the increase was greater in the study group than in the control group (P < 0.05); the incidence of complications was 18.9% and 5.9% in the study and control groups, respectively, and the incidence of complications was lower in the study group than in the control group (P < 0.05); and the incidence of complications was lower in the study group than in the control group (P < 0.05). After care, patients' anxiety and depression scores were significantly lower, and satisfaction scores were significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, patients' 6-minute walking distance was significantly higher in both groups, with a greater change in the study group than in the control group (P < 0.05); after care, LVEF indicators were significantly higher, and LVESD and LVED indicators were significantly higher, with a greater change in the study group than in the control group. After care, LVEF indexes increased significantly in both groups, while LVESD and LVED indexes decreased significantly in the study group, with a greater change than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a greater increase in the study group than in the control group (P < 0.05); after care, systolic blood pressure and heart rate increased significantly in both groups, with a more significant increase.

Conclusion

Targeted nursing for patients with severe cardiac disease after thoracoscopic surgery has a significant effect, which can improve patients' anxiety and depression, significantly improve patients' self-care ability and quality of life, and at the same time improve patients' cardiac function, heart rate, and blood pressure, with high patient satisfaction.

Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry

Background

Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation.

Methods

This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI).

Results

The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST].

Conclusions

The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.