Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: An algorithm for percutaneous management
Ej. Dippel et al., Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: An algorithm for percutaneous management, CATHET C IN, 52(3), 2001, pp. 279-286
Coronary perforation is an uncommon but potentially life-threatening compli
cation of percutaneous coronary intervention. The use of both atheroablativ
e technologies for coronary intervention and adjunctive platelet glycoprote
in blockade pharmacology may increase the incidence of or risk for life-thr
eatening bleeding complications following the occurrence of coronary artery
perforation. The interventional database for 6,214 percutaneous coronary i
nterventions performed between January 1995 and June 1999 was analyzed. Hos
pital charts and cine angiograms for all patients identified in the databas
e as having had coronary perforation were reviewed. Coronary perforation co
mplicated 0.58% of all procedures and was more commonly observed in patient
s with a history of congestive heart failure and following use of atheroabl
ative interventional technologies (2.8%). There was no association of abcix
imab therapy with either the incidence of or classification for coronary pe
rforation. Adverse clinical outcomes (death, emergency surgical exploration
) were related to the angiographic classification of perforation and were m
ore frequently observed in patients who experienced a class 3 coronary perf
oration. These data suggest that specific clinical and procedural demograph
ic factors are associated with the occurrence and severity of angiographic
coronary perforation. An angiographic perforation class-specific algorithm
for treatment of coronary perforation is proposed. (C) 2001 Wiley-Liss, Inc
.