- Title
- Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study
- Creator
- Ford, Thomas J.; Adamson, Carly; Eteiba, Hany; Robertson, Keith; Berry, Colin; Oldroyd, Keith G.; McEntegart, Margaret; Morrow, Andrew J.; Rocchiccioli, Paul; Collison, Damien; McCartney, Peter J.; Shaukat, Aadil; Lindsay, Mitchell; Good, Richard; Watkins, Stuart
- Relation
- Journal of the American Heart Association Vol. 11, Issue 19, no. e024492
- Publisher Link
- http://dx.doi.org/10.1161/JAHA.121.024492
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2022
- Description
- 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 hours. 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: Clinicaltrials.gov. Identifier: NCT03862352.
- Subject
- coronary artery perforation; coronary stent occlusion; covered coronary stent; outcomes; stent thrombosis; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1487931
- Identifier
- uon:52298
- Identifier
- ISSN:2047-9980
- Rights
- x
- Language
- eng
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