Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation
<b>Background:</b> Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused o...
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| Language: | English |
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MDPI AG
2020-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/9/3043 |
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| author | Michał A. Surdacki Marcin Major Michał Chyrchel Paweł Kleczyński Tomasz Rakowski Leszek Bryniarski Marek Ujda Renata Wysocka Witold Żmuda Andrzej Wiśniewski Marcin Nosal Maciej Maliszewski Marcin Rzeszutko Jacek Legutko Andrzej Surdacki Stanisław Bartuś Łukasz Rzeszutko |
| author_facet | Michał A. Surdacki Marcin Major Michał Chyrchel Paweł Kleczyński Tomasz Rakowski Leszek Bryniarski Marek Ujda Renata Wysocka Witold Żmuda Andrzej Wiśniewski Marcin Nosal Maciej Maliszewski Marcin Rzeszutko Jacek Legutko Andrzej Surdacki Stanisław Bartuś Łukasz Rzeszutko |
| author_sort | Michał A. Surdacki |
| collection | DOAJ |
| description | <b>Background:</b> Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. <b>Methods:</b> From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAP<sub>III</sub>) over a 15-year period (2005–2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAP<sub>III</sub> and without tamponade (n = 60). <b>Results:</b> CAP<sub>III</sub> were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAP<sub>III</sub> in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAP<sub>III</sub> in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAP<sub>III</sub> in the remaining coronary arteries (23%) (<i>p</i> = 0.24). However, when CAP<sub>III</sub> in the LCx were separated from CAP<sub>III</sub> in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAP<sub>III</sub> in the LCx (54%, 7 of 13) compared to subjects with CAP<sub>III</sub> in an artery other than the LCx (21%, 14 of 68) (<i>p</i> = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, <i>p</i> = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, <i>p</i> = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. <b>Conclusions:</b> CAP<sub>III</sub> in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes. |
| first_indexed | 2024-03-10T16:09:54Z |
| format | Article |
| id | doaj.art-aa9c9428d5414b1f9b9ae4c7603d8255 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T16:09:54Z |
| publishDate | 2020-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-aa9c9428d5414b1f9b9ae4c7603d82552023-11-20T14:32:50ZengMDPI AGJournal of Clinical Medicine2077-03832020-09-0199304310.3390/jcm9093043Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery PerforationMichał A. Surdacki0Marcin Major1Michał Chyrchel2Paweł Kleczyński3Tomasz Rakowski4Leszek Bryniarski5Marek Ujda6Renata Wysocka7Witold Żmuda8Andrzej Wiśniewski9Marcin Nosal10Maciej Maliszewski11Marcin Rzeszutko12Jacek Legutko13Andrzej Surdacki14Stanisław Bartuś15Łukasz Rzeszutko16Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandStudents’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandDepartment of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandInterventional Cardiology Department, District Hospital, 37-450 Stalowa Wola, PolandCenter for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sącz, PolandCenter for Invasive Cardiology, Electrotherapy and Angiology, 32-600 Oświęcim, PolandSubcarpathian Cardiovascular Intervention Center, 38-500 Sanok, PolandCenter for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Krosno, PolandInvasive Cardiology, Electrotherapy and Angiology Center, 27-400 Ostrowiec Świętokrzyski, PolandDepartment of Cardiology, District Hospital, 42-300 Myszków, PolandDepartment of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, PolandSecond Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland<b>Background:</b> Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. <b>Methods:</b> From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAP<sub>III</sub>) over a 15-year period (2005–2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAP<sub>III</sub> and without tamponade (n = 60). <b>Results:</b> CAP<sub>III</sub> were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAP<sub>III</sub> in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAP<sub>III</sub> in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAP<sub>III</sub> in the remaining coronary arteries (23%) (<i>p</i> = 0.24). However, when CAP<sub>III</sub> in the LCx were separated from CAP<sub>III</sub> in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAP<sub>III</sub> in the LCx (54%, 7 of 13) compared to subjects with CAP<sub>III</sub> in an artery other than the LCx (21%, 14 of 68) (<i>p</i> = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, <i>p</i> = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, <i>p</i> = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. <b>Conclusions:</b> CAP<sub>III</sub> in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes.https://www.mdpi.com/2077-0383/9/9/3043coronary perforationcardiac tamponadepercutaneous coronary interventionleft circumflex coronary artery |
| spellingShingle | Michał A. Surdacki Marcin Major Michał Chyrchel Paweł Kleczyński Tomasz Rakowski Leszek Bryniarski Marek Ujda Renata Wysocka Witold Żmuda Andrzej Wiśniewski Marcin Nosal Maciej Maliszewski Marcin Rzeszutko Jacek Legutko Andrzej Surdacki Stanisław Bartuś Łukasz Rzeszutko Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation Journal of Clinical Medicine coronary perforation cardiac tamponade percutaneous coronary intervention left circumflex coronary artery |
| title | Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation |
| title_full | Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation |
| title_fullStr | Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation |
| title_full_unstemmed | Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation |
| title_short | Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation |
| title_sort | urgent pericardiocentesis is more frequently needed after left circumflex coronary artery perforation |
| topic | coronary perforation cardiac tamponade percutaneous coronary intervention left circumflex coronary artery |
| url | https://www.mdpi.com/2077-0383/9/9/3043 |
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