Guidewire-induced coronary artery perforation and tamponade during PCI: in-hospital outcomes and impact on long-term survival.

BACKGROUND: Guidewire-induced coronary perforation (CP) rate is reported to have increased.

METHODS: We analyzed 23,399 PCIs and identified 73 patients complicated by CP, of which 31 were guidewire induced. Patients were divided into two groups: group A (guidewire-induced CP) and group B (non-guidewire induced CP). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of guidewire-induced CP on mortality.

RESULTS: Group A patients had more PCIs on CTO lesions (P=.001). Group A showed a trend for higher tamponade (P=.08). Delayed tamponade occurred only in group A (P<.001). Polytetrafluoroethylene stents were used more often in group B (P<.01). In-hospital mortality was similar between groups (3.2% vs. 7.1%; P=NS). Emergent cardiac surgery was needed in 5.5% of all CP patients and was similar between groups. Group A had a trend for better survival (hazard ratio [HR], 0.37; 95% CI, 0.12-1.10; P=.07). Tamponade conferred a 3-fold increase in the long-term probability of death (HR, 2.95; 95% CI, 1.07-8.13; P=.04). Guidewire-induced CP during elective PCI had the best survival (HR, 0.31; 95% CI, 0.11-0.87; P=.03).

CONCLUSIONS: Guidewire-induced CP rate is low. In-hospital mortality was similar for patients with guidewire-induced and non-guidewire induced perforations. Presentation of tamponade was occasionally delayed and associated with increased early and late death. Percutaneous coronary intervention of lesions with an expected increased risk of CP should be undertaken with consideration of the short- and long-term risk, particularly during non-elective PCI since tamponade in this setting increased the risk of late death by nearly 3-fold.