Early and Long-Term Outcomes in Patients Undergoing Cardiac Surgery Following Iatrogenic Injuries During Percutaneous Coronary Intervention

• Published in: Journal of the American Heart Association Vol. 8; no. 1; p. e010940
• Main Authors: Verevkin, Alexander, von Aspern, Konstantin, Leontyev, Sergey, Lehmann, Sven, Borger, Michael A, Davierwala, Piroze M
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 08.01.2019; Wiley
• Subjects: Aged; aortic surgery; complication; Coronary Angiography; Coronary Artery Bypass - methods; coronary artery bypass graft surgery; Coronary Occlusion - epidemiology; Coronary Occlusion - etiology; Coronary Occlusion - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - injuries; Female; Follow-Up Studies; Germany - epidemiology; Humans; Iatrogenic Disease; Incidence; Male; Original Research; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation; Retrospective Studies; surgery; Survival Rate - trends; Time Factors; Treatment Outcome; Germany; coronary artery bypass graft surgery; complication; percutaneous coronary intervention; aortic surgery; surgery
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/jaha.118.010940

Background Iatrogenic coronary artery injuries during percutaneous coronary interventions ( PCI ) often require emergent surgical management. Our study evaluated the early and long-term outcomes in patients undergoing surgical treatment of iatrogenic PCI complications and identified the predictors of operative and long-term mortality. Methods and Results Pre-, intra- and post-operative data and hospital outcomes of 168 consecutive patients undergoing cardiac surgical procedures for iatrogenic complications following PCI between December 1999 and July 2015, were prospectively collected in our computerized database. Logistic and Cox regression analyses were used to identify the independent predictors of operative and long-term mortality. The mean age was 68.5±10.2 years and 35.7% were females. PCI complications included left anterior descending (38.7%), right coronary (29.2%), circumflex (13.1%), left main coronary artery injuries (19.0%), and acute myocardial infarction (66.7%), Type A aortic dissection (7.7%), cardiac tamponade (17.9%), and cardiogenic shock ( CS ) (46.4%). Operative mortality for corrective surgery was 20.8% and was independently predicted by critical preoperative state (odds ratio: 3.5; P=0.01). The 5- and 10-year survival for all patients was 63.9±4.0% and 49.6±5.0%, which improved remarkably in hospital survivors (79.0±4.0% and 64.0±6.0%). Risk factors for long-term mortality were critical preoperative state (hazard ratio: 3.5; P<0.0001) and coronary artery occlusion during PCI (hazard ratio: 2.6; P=0.002). The 5- and 10-year freedom from major adverse cardiac and cerebrovascular events was 59.7±4.0% and 41.9±5.0%. Conclusions Iatrogenic injuries after PCI or coronary angiography requiring surgical correction are associated with a high operative and long-term mortality. Patients developing acute coronary artery occlusion have a more guarded long-term prognosis. Hospital survivors, however, have a superior long-term survival.