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Coronary Artery Perforation Much-Feared PCI Complication

Technical advances have not diminished the risk

THURSDAY, Oct. 5 (HealthDay News) -- Despite advances in the management of percutaneous coronary intervention (PCI), coronary perforation remains a feared complication with high in-hospital mortality, according to a study in the Oct. 1 issue of the American Journal of Cardiology.

Aamir Javaid, M.B.B.S., of Washington Hospital Center in Washington, D.C., and colleagues conducted a study of 72 patients who sustained coronary perforation during PCI. They reviewed records and analyzed angiographs to ascertain trends in incidence, management and outcomes. The patients were followed up after one year.

The only predictors of mortality were the grade of perforation and the presence of chronic renal insufficiency. Even though the use of polytetrafluoroethylene-covered stents constitutes an advance in management, their use had no impact on adverse outcomes such as development of tamponade, the need for emergency coronary artery bypass grafting or in-hospital death.

"In conclusion, coronary perforation remains a feared complication in the contemporary interventional era with significant in-hospital mortality. Emphasis should be placed on preventing this complication whenever possible, including exercising particular caution in patients with chronic renal insufficiency. The treatment of such patients should be tailored to the severity of the perforation," the authors conclude.

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