Legacy Effect of Coronary Perforation Complicating Percutaneous Coronary Intervention for Chronic Total Occlusive Disease
| Autor: | Mamas A. Mamas, Julian Strange, Colm G. Hanratty, James C. Spratt, Elliot J. Smith, Mark deBelder, David Hildick-Smith, Tim Kinnaird, Nicholas Ossei-Gerning, Simon J Walsh, Alex Sirker, Richard Anderson, James Cockburn, Peter Ludman |
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| Rok vydání: | 2017 |
| Předmět: |
Male
British cardiovascular intervention society medicine.medical_specialty Time Factors Databases Factual medicine.medical_treatment Perforation (oil well) Occlusive disease Kaplan-Meier Estimate 030204 cardiovascular system & hematology Risk Assessment Stable angina Total occlusion 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Risk Factors Internal medicine Cardiac tamponade Odds Ratio medicine Humans 030212 general & internal medicine Aged Proportional Hazards Models Wales business.industry Incidence Incidence (epidemiology) Percutaneous coronary intervention Middle Aged medicine.disease Coronary Vessels Logistic Models Treatment Outcome Coronary Occlusion England Heart Injuries Chronic Disease Multivariate Analysis Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Cardiovascular Interventions. 10 |
| ISSN: | 1941-7632 1941-7640 |
| DOI: | 10.1161/circinterventions.116.004642 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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