Prevalence and outcomes of coronary artery perforation during percutaneous coronary intervention

EuroIntervention. 2017 Aug 4;13(5):e595-e601. doi: 10.4244/EIJ-D-16-01038.


Aims: We aimed to examine the prevalence, clinical outcomes and procedural characteristics of percutaneous coronary intervention (PCI) complicated by coronary artery perforation (CAP) in a contemporary patient population.

Methods and results: Procedural records of 39,115 patients undergoing PCI between 2005 and 2016 were reviewed. CAP affected 149 cases (0.37%). The prevalence of CAP increased from 0.31% in 2005 to 0.45% in 2016 (p=0.03), reflecting an increase in more complex PCI (from 14% in 2005 to 21% in 2016; p<0.0001). CAP was associated with increased all-cause mortality (23.1% vs. 9.4% in those without perforation; p=0.0054) and was an independent predictor of mortality (HR 2.55; 95% CI: 1.34-4.78). In-patient mortality was 4% (6/149). In 43 of 149 (28.9%) cases, a significant pericardial effusion ensued and mortality rates were higher in this subgroup. Thirty-one patients had covered stents (CS) inserted and five did not survive to discharge. Of the 26 patients with a CS who survived to hospital discharge, six (23.1%) had definite stent thrombosis, and two (7.7%) had possible/probable stent thrombosis.

Conclusions: CAP remains uncommon but the prevalence is increasing. CAP is associated with significant short- and long-term mortality, particularly when there is haemodynamic compromise necessitating pericardiocentesis. Covered stents are a valuable tool but they are associated with a high risk of stent thrombosis.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / methods
  • Coronary Angiography / methods
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / etiology
  • Coronary Vessels / physiopathology*
  • Drug-Eluting Stents
  • Female
  • Heart Injuries / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / methods
  • Prevalence
  • Risk Factors
  • Thrombosis / epidemiology
  • Treatment Outcome