Original Contribution
Table 1: Demographic Features Age (Mean)
Male sex %
Diabetes mellitus % Hypertension %
Previous percutaneous coronary
intervention % Previous coronary artery bypass graft %
Table 2: Angiographic Features Revealed
Angiographic features VESSEL SITE
Left anterior descending Proximal Mid
Distal Left circumflex Right coronary artery
Pre-treatment stenosis range PRE-TREATMENT LESION SEVERITY
A B
C
Reference vessel diameter range (mm) TYPE
Wire-related (8) Balloon-related (14)
Hydrophilic wire
Hydrophobic wire
Balloon
inflation-related Stent-related
Proximal Mid
Distal 0
5 (22.7 %) 6 (27.2 %) 4 (18.2 %) 0
2 (9.2 %) 5 (22.7 %) 65–99 %
2 6 4
1.5–4.0 3 5
10 4
Perforations were classified according to the previously stated angiographic criteria of Ellis et al.:2
Type 1, described as a crater extending outside the
lumen only; Type 2, resulting in pericardial or myocardial blush without a >1 mm exit hole; Type 3, described as frank streaming of contrast through a >1 mm exit hole; and Type 3, with cavity spilling as a perforation into an anatomic chamber.
Table 3: Angiographic Features Also Showed Mean balloon:artery ratio
Mean inflation pressure in mmHg Mean number of inflations Mean balloon length in mm Calcification
Myocardial bridging Results
Demographic and angiographic features are revealed in Tables 1 and 2.
Outcomes
Nine patients were treated conservatively and six patients were treated with prolonged balloon inflation. Six patients were treated with PTFE-covered stents. One patient required emergency coronary artery bypass graft. No deaths were reported.
Role of Arterial Inflammation
Group I had a significantly higher total WBC count (means 12,134 versus 6,155, 95 % confidence interval [CI], p<0.0001, n=22), total absolute neutrophil count (means 74.2 % versus 57.1 %, 95 % CI, p<0.0001, n=22), and N/L ratio (means 3.65 versus 1.50, 95 % CI, p<0.0001, n=22).
Discussion 1.23
13.07 2
16.714 4 2
and retrieval of records from a computerized catheterization laboratory database. The study design was approved by the institutional review board (IRB) at Maimonides Medical Center. We reviewed patient charts and reports. Two independent operators, in a blinded approach, reviewed all procedural cineangiograms. Data were analyzed by simple statistical methodology. Twenty-two subjects out of 30,798
88
Types 1 and 2 perforations had classically been treated conservatively, while Type 3 required emergency pericardiocentesis. In our series, most of the patients fared well with conservative treatment. Hypertension, small vessel diameter, high balloon:artery ratio, use of hydrophilic wires, and presence of myocardial bridging were strongly associated with perforations and may be postulated to be hitherto unknown possible risk factors. A recent article has put forward a dual catheter technique for treatment of severe CP (Ellis Type 2 or 3), which may reduce requirements for emergency surgery even more for CP.14
Our data also suggest a
pre-procedural elevated WBC count, with an elevated percentage of neutrophils and an elevated N/L ratio, is a predictor of CP in patients undergoing PCI, thereby indicating a possible role of arterial inflammation in causing friability of arterial walls15
tendency for CPs in subjects. This hypothesis will soon be tested with a larger sample size in pilot study using American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) data. n
Predisposing Factors, Demographics, Angiographic Features, and the Possible Role of Inflammation in Coronary Perforations Winter 2011
The American Heart Hospital Journal
68 (Range 32–82) 72.72 36.36 81.81 36.36
9
subjects undergoing PCI (0.07 %) met criteria for inclusion in the study. We also tabulated their white blood cell (WBC) counts and absolute neutrophil (N) and lymphocyte (L) counts (as percentages), as well as N/L ratios (Group I). We compared the data with a random group of age- and gender-matched controls (n=22), with similar lesion characteristics but without perforations (Group II), from our database. The authors of this article have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.13
leading to greater
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