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Title: Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study
Authors: Ford, Tom ;Adamson, Carly;Morrow, Andrew J;Rocchiccioli, Paul;Collison, Damien;McCartney, Peter J;Shaukat, Aadil;Lindsay, Mitchell;Good, Richard;Watkins, Stuart;Eteiba, Hany;Robertson, Keith;Berry, Colin;Oldroyd, Keith G;McEntegart, Margaret
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: 4-Oct-2022
Source: 11(19):e024492
Journal title: Journal of the American Heart Association
Department: Cardiology
Abstract: Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24┬áhours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (r=0.73; P<0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), P<0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; P<0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; P=0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Identifier: NCT03862352.
DOI: 10.1161/JAHA.121.024492
Publicaton type: Journal Article
Keywords: Cardiology
Heart Disease
Cardiovascular Disease
Appears in Collections:Cardiology

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