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Predictors, treatment, and long‐term outcomes of coronary perforation during retrograde percutaneous coronary intervention via epicardial collaterals for recanalization of chronic coronary total occlusion
Author(s) -
Wu Kaize,
Huang Zehan,
Zhong Zhian,
Liao Hongtao,
Zhou Yi,
Luo Bingzheng,
Zhang Bin
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28093
Subject(s) - medicine , percutaneous coronary intervention , mace , conventional pci , cardiology , hazard ratio , pericardiocentesis , odds ratio , perforation , confidence interval , myocardial infarction , surgery , cardiac tamponade , materials science , punching , metallurgy
Objective To investigate predictors, treatment, and long‐term outcomes associated with coronary perforation (CP) in patients who underwent retrograde percutaneous coronary intervention (PCI) through epicardial collaterals for chronic total occlusion (CTO). Background Data regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce. Methods We included 155 patients who underwent retrograde CTO PCI through epicardial collaterals at Guangdong Cardiovascular Institute from August 2011 to December 2017. The median follow‐up was 2.5 years. Major adverse cardiac events (MACEs) were analyzed using the Kaplan–Meier method, and independent predictors of long‐term MACE were determined using a multivariable Cox model. Results CP occurred in 24 (15.5%) patients, with the frequency of Ellis classes 1 or 2 and 3 being 41.7% and 58.3%, respectively. Seven (4.5%) patients had tamponade, which was effectively managed using coil embolization and pericardiocentesis. Renal dysfunction (odds ratio [OR]: 5.27; 95% confidence interval [CI]: 1.47–18.88; P = 0.011), right coronary artery (RCA) CTO (OR: 4.34; 95% CI: 1.29–14.63; P = 0.018), and Epi‐CTO score ≥ 2 (OR: 3.27; 95% CI: 1.12–9.58; P = 0.030) were independent predictors of CP. At the 7‐year follow‐up, 17 patients had MACE. Multivariable analysis revealed that CP was not associated with worse long‐term clinical outcomes (hazard ratio: 1.55; 95% CI: 0.45–5.32, P = 0.484). Conclusions Retrograde CTO PCI through epicardial collaterals is at increased risk of CP, which is associated with renal dysfunction, RCA CTO, and Epi‐CTO score ≥ 2. Prompt and proper management of CP is important. CP is not significantly associated with adverse clinical outcomes.