Analysis of risk factors and treatment strategy for coronary perforation in patients underwent coronary intervention

Abstract

Objective The aim of this study was to determine the risk factors and treatment strategy for coronary artery perforation (CAP) in patients underwent percutaneous coronary intervention(PCI). Methods A total of 12 113 patients who underwent PCI in our hospital from January 2005 to December 2014 were reviewed.Of which 64 patients with CAP and 192 randomly extracted controls were selected.Clinical data and findings of coronary angiography and PCI were analyzed and compared.According to Ellis points, CAP were divided into type Ⅰ, Ⅱ or Ⅲ.Logistic regression was used to evaluate the risk factors of CAP and the treatment strategy were also discussed. Results The incidence of CAP in patients undergoing PCI was 0.53% (64/12 113), and the mortality was 7.8% (5/64). Logistic regression analysis showed that risk factors included female gender (OR: 2.207, P=0.03), hypertension (OR: 3.194, P<0.01), non-ST-elevation acute coronary syndrome (NSTE-ACS) (OR: 3.339, P<0.01), right coronary artery (RCA) lesion (OR: 2.517, P=0.02), calcified lesion (OR: 4.273, P<0.01), and chronic total occlusion (CTO) (OR: 5.077, P<0.01). Patients with type Ⅰ CAP underwent conservative treatment.Patients with type Ⅱ CAP underwent conservative treatment or low-pressure balloon dilatation (61.1% and 22.2%, respectively). Patients with type Ⅲ CAP underwent low-pressure balloon dilatation, coated-stent implantation, and emergency surgery (40.9%, 27.3% and 22.7%, respectively). Conclusions CAP risk factors in patients from our hospital underwent PCI included CTO, NSTE-ACS, hypertension, calcified and RCA lesions, and female gender, CTO had the highest risk .Different treatment methods should be used according to the different classes of CAP. Key words: Coronary artery disease; Angioplasty, transluminal, percutaneous coronary; Coronary artery perforation; Risk factors; Treatment