Coronary Artery Perforation: Insights and Outcomes From a 13-Year Experience at a District General Hospital

Abstract

Introduction and Objectives: Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention (PCI). Although its management is well-studied in tertiary care settings, little is known about the incidence and treatment patterns at district general hospitals (DGHs), which this study explored.

Materials and Methods: A single-centre analysis of all PCI procedures in a DGH between January 2011 and December 2023 was performed. Patients’ records were examined for procedure details and endpoints, which included pericardiocentesis, emergency cardiac surgery and secondary coronary artery bypass grafting. The endpoints also included in-hospital and one-year mortalities.

Results: During the study period, there were 13,480 PCIs, of which 31 (0.23%) were complicated by CAP. Males composed 65%, and the mean age was 69.9 ± 10 years. The most common perforation type was Ellis II in 45% of patients, and the left anterior ascending artery (LAD) was most affected in 55% of patients. An echocardiogram was done in all patients and showed tamponade physiology in 16%, in all of whom pericardiocentesis was performed. Other CAP treatments included balloon tamponade in 65%, covered stent in 42%, fat embolisation in 10% and emergency surgery and coiling in 6% each. Inpatient mortality occurred in three patients (10%), with no one-year mortalities. Long-term complications were not observed in the study.

Conclusion: CAP remains a rare, potentially lethal complication of PCI in a DGH setting, with an incidence, pattern and treatments similar to those of high-volume PCI teaching centres. Early recognition and proper management are crucial.