Legacy Effect of Coronary Perforation Complicating Percutaneous Coronary Intervention for Chronic Total Occlusive Disease: An Analysis of 26 807 Cases From the British Cardiovascular Intervention Society Database.

Autor:	Kinnaird T; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.). tim.kinnaird2@wales.nhs.uk., Anderson R; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Ossei-Gerning N; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Cockburn J; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Sirker A; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Ludman P; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., deBelder M; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Walsh S; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Smith E; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Hanratty C; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Spratt J; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Strange J; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Hildick-Smith D; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.)., Mamas MA; From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (S.W., C.H.); Department of Cardiology, St Bartholomew's Hospital, London (E.S.); Department of Cardiology, Edinburgh Royal Infirmary, United Kingdom (J. Spratt); Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J. Strange); and Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom (M.A.M.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2017 May; Vol. 10 (5).
DOI:	10.1161/CIRCINTERVENTIONS.116.004642
Abstrakt:	Background: Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited, and the long-term effects are unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during CTO-PCI were defined. Methods and Results: Data analyzed from the British Cardiovascular Intervention Society data set on all CTO-PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. A total of 376 CP were recorded from 26 807 CTO-PCI interventions (incidence of 1.40%) with an increase in frequency during the study period ( P =0.012). Patient-related factors associated with an increased risk of CP were age and female sex. Procedural factors indicative of complex CTO intervention strongly related to an increased risk of CP with a close relationship between the number of complex strategies used and CP evident ( P =0.008 for trend). Tamponade occurred in 16.6% and emergency surgery in 3.4% of cases. Adverse outcomes were frequent in those patients with perforation including bleeding, transfusion, myocardial infarction, and death. A legacy effect of perforation on mortality was evident, with an odds ratio for 12-month mortality of 1.60 for perforation survivors compared with matched nonperforation survivors without a CP ( P <0.0001). Conclusions: Many of the factors associated with an increased risk of CP were related to CTO complexity. Perforation was associated with adverse outcomes, with a legacy effect on later mortality after CP also observed. (© 2017 American Heart Association, Inc.)
Databáze:	MEDLINE
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