Contemporary Trends, Predictors and Outcomes of Perforation During Percutaneous Coronary Intervention (From the NCDR Cath PCI Registry)

      Coronary artery perforation (CP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). Given the marked increase in high-risk and complex PCIs, careful review and understanding of PCI complications may help to improve procedural and clinical outcomes. Our aim was to study the trends, predictors and outcomes of CP in the contemporary era. This cross-sectional multicenter analysis included data collected from institutions participating in the National Cardiovascular Data Registry CathPCI Registry between July 2009 and June 2015. Multivariable logistic regression models were created to identify predictors of CP and compare the in-hospital outcomes of CP and non-CP patients. Of 3,759,268 PCIs performed during the study period, there were 13,779 CP (0.37%). During the study period, the proportion of PCI that developed CP remained unchanged (0.33% to 0.4%) (p for trend 0.16). Chronic total occlusion (CTO) PCI as percentage of total PCI volume increased over the study period (3% to 4%) (p for trend <0.001) with a concomitant significant increase in CTOs with perforation (1.2% to 1.5%, p for trend = 0.02). CTO PCI (Odds Ratio [OR] 2.59) female gender (OR 1.38), saphenous vein graft PCI (OR 1.2), ACC Type C lesion (1.48), cardiogenic shock on presentation (1.15), and use of atherectomy (laser/ rotational) (OR 2.38) were significant predictors of CP. CP patients had significantly higher rates of cardiogenic shock (7.73% vs 1.02%), tamponade (9.6% vs 0.05%) and death (4.87% vs 1.14%) compared with those without CP. Strongest predictors of any adverse events amongst CP were cardiogenic shock (OR 3.93), cardiac arrest (OR 2.02) and use of atherectomy device (OR 2.5). Use of covered stents was also strongly associated with adverse events (OR 3.67) reflecting severity of these CPs. CP in CTO PCI had higher rates of any adverse event than non-CTO CP (26.8% vs 22%, p < 0.001). However non-CTO CP had higher rates of coronary artery bypass grafting (CABG) (urgent, emergent, or salvage) (5.8% vs 4.5%, p = 0.03) and death (6.9% vs 5.6%, p = 0.04). CP in CABG PCI had fewer adverse events compared with those without previous CABG (16.1% vs 24.7%). In a large real world experience, we identified several clinical and procedural factors associated with increased risk of CP and adverse outcomes. The trends in CP remained constant over the study period.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Colli A
        • Ninot S
        • Josa M
        Coronary artery perforation complicated by cardiac rupture during conventional PCI.
        Eur Heart J. 2007; 28: 545
        • Kinnaird T
        • Kwok CS
        • Kontopantelis E
        • Ossei-Gerning N
        • Ludman P
        • deBelder M
        • Anderson R
        Mamas MA; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research. incidence, determinants, and outcomes of coronary perforation during Percutaneous Coronary Intervention in the United Kingdom between 2006 and 2013: an analysis of 527 121 cases from the British Cardiovascular Intervention Society Database.
        Circ Cardiovasc Interv. 2016; 9 (pii: e003449)
        • Bauer T
        • Boeder N
        • Nef HM
        • Möllmann H
        • Hochadel M
        • Marco J
        • Weidinger F
        • Zeymer U
        • Gitt AK
        • Hamm CW
        Fate of patients with coronary perforation complicating percutaneous coronary intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry).
        Am J Cardio. 2015; 116: 1363-1367
        • Shimony A
        • Joseph L
        • Mottillo S
        • Eisenberg MJ
        Coronary artery perforation during percutaneous coronary intervention: a systematic review and meta-analysis.
        Can J Cardiol. 2011; 27: 843-850
        • Hendry C
        • Fraser D
        • Eichhofer J
        • Mamas MA
        • Fath-Ordoubadi F
        • El-Omar M
        • Williams P
        Coronary perforation in the drug-eluting stent era: incidence, risk factors, management and outcome: the UK experience.
        Euro Intervention. 2012; 8: 79-86
        • Al-Lamee R
        • Ielasi A
        • Latib A
        • Godino C
        • Ferraro M
        • Mussardo M
        • Arioli F
        • Carlino M
        • Montorfano M
        • Chieffo A
        • Colombo A
        Incidence, predictors, management, immediate and long-term outcomes following grade III coronary perforation.
        JACC Cardiovasc Interv. 2011; 4: 87-95
        • Javaid A
        • Buch AN
        • Satler LF
        • Kent KM
        • Suddath WO
        • Lindsay Jr, J
        • Pichard AD
        • Waksman R
        Management and outcomes of coronary artery perforation during percutaneous coronary intervention.
        Am J Cardiol. 2006; 98: 911-914
        • Ellis SG
        • Ajluni S
        • Arnold AZ
        • Popma JJ
        • Bittl JA
        • Eigler NL
        • Cowley MJ
        • Raymond RE
        • Safian RD
        • Whitlow PL
        Increased coronary perforation in the new device era. Incidence, classification, management, and outcome.
        Circulation. 1994; 90: 2725-2730
        • Messenger JC1
        • Ho KK
        • Young CH
        • Slattery LE
        • Draoui JC
        • Curtis JP
        • Dehmer GJ
        • Grover FL
        • Mirro MJ
        • Reynolds MR
        • Rokos IC
        • Spertus JA
        • Wang TY
        • Winston SA
        • Rumsfeld JS
        • Masoudi FA
        • NCDR Science and Quality Oversight Committee Data Quality Workgroup
        NCDR science and quality oversight committee data quality workgroup.The National Cardiovascular Data Registry (NCDR) data quality brief: the NCDR data quality program in 2012.
        J Am Coll Cardiol. 2012; 60: 1484-1488
        • Brindis RG
        • Fitzgerald S
        • Anderson HV
        • Shaw RE
        • Weintraub WS
        • Williams JF
        The American college of cardiology-national cardiovascular data registryTM (ACC-NCDRTM): building a national clinical data repository.
        J Am Coll Cardiol. 2001; 37: 2240-2245
        • van Buuren S
        Multiple imputation of discrete and continuous data by fully conditional specification.
        Stat Methods Med Res. 2007; 16: 219-242
        • Patel VG
        • Brayton KM
        • Tamayo A
        • Mogabgab O
        • Michael TT
        • Lo N
        • Alomar M
        • Shorrock D
        • Cipher D
        • Abdullah S
        • Banerjee S
        • Brilakis ES
        Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies.
        JACC Cardiovasc Interv. 2013; 6: 128-136
        • Karatasakis A
        • Akhtar YN
        • Brilakis ES
        Distal coronary perforation in patients with prior coronary artery bypass graft surgery: the importance of early treatment.
        Cardiovasc Revasc Med. 2016; 17: 412-417
        • Doll JA
        • Nikolsky E
        • Stone GW
        • Mehran R
        • Lincoff AM
        • Caixeta A
        • McLaurin B
        • Cristea E
        • Fahy M
        • Kesanakurthy V
        • Lansky AJ
        Outcomes of patients with coronary artery perforation complicating percutaneous coronary intervention and correlations with the type of adjunctive antithrombotic therapy: pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials.
        J Interv Cardiol. 2009; 22: 453-459
        • Kawamoto H
        • Tanaka K
        • Ruparelia N
        • Takagi K
        • Yabushita H
        • Watanabe Y
        • Mitomo S
        • Matsumoto T
        • Naganuma T
        • Fujino Y
        • Ishiguro H
        • Tahara S
        • Kurita N
        • Nakamura S
        • Hozawa K
        • Nakamura S
        Short-term and long-term outcomes after polytetrafluoroethylene-covered stent implantation for the treatment of coronary perforation.
        Am J Cardiol. 2015; 116: 1822-1826