BACKGROUND: Coronary perforation is currently a rare, but potentially catastrophic complication. The aim of the study was to evaluate the incidence, predictors, management and prognosis of coronary perforations at a hospital with a large number of percutaneous coronary interventions (PCIs). METHODS: Clinical, angiographic, procedural and in-hospital outcomes of patients with or without coronary perforations were compared. Univariate analysis was performed to determine the predictors of this complication. RESULTS: From December 2007 to January 2012, 5,585 consecutive patients were submitted to PCI and 18 had coronary perforation (0.32%), of whom 55.5% were female and 38.9% were diabetic. In this group, the left anterior descending artery was the most frequently treated vessel (61.1%) as well as type C lesion (61.1%) and chronic occlusions were approached in 27.8% of these cases. Most of the coronary perforations (11/18) had a lower complexity according to the modified Ellis classification, whereas the remaining perforations were classified as grades III (6/18) or IV (1/18). The balloon-catheter device was responsible for perforation in 61.1% of the cases. Prolonged inflation with a balloon-catheter and heparin reversal with protamine was performed in 72.2% and 88.9% of the cases, respectively. Only 1 patient (5.6%) required an emergency surgery due to cardiac tamponade. There were no deaths associated with coronary perforation. According to the univariate analysis, coronary perforation predictors were: female gender (P = 0.03), chronic obstructive pulmonary disease (P = 0.006) and chronic occlusion (P < 0.01). CONCLUSIONS: In our experience, coronary perforation was a rare event, which was managed conservatively in most of the cases and was associated with a good in-hospital outcome.
Coronary artery disease; Coronary stenosis; Coronary angiography; Angioplasty
