Coronary artery perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study

Ford, T. J. et al. (2022) Coronary artery perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study. Journal of the American Heart Association, 11(19), e024492. (doi: 10.1161/JAHA.121.024492) (PMID:36129052) (PMCID:PMC9673697)

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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: Identifier: NCT03862352.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Robertson, Dr Keith and Shaukat, Dr Aadil and Ford, Thomas and McEntegart, Dr Margaret and Good, Dr Richard and Collison, Dr Damien and McCartney, Dr Peter and Eteiba, Dr Hany and Oldroyd, Dr Keith and Adamson, Dr Carly and Watkins, Dr Stuart and Morrow, Dr Andrew
Authors: Ford, T. J., Adamson, C., Morrow, A. J., Rocchiccioli, P., Collison, D., McCartney, P. J., Shaukat, A., Lindsay, M., Good, R., Watkins, S., Eteiba, H., Robertson, K., Berry, C., Oldroyd, K. G., and McEntegart, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the American Heart Association
Publisher:American Heart Association
ISSN (Online):2047-9980
Published Online:21 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American Heart Association 11(19): e024492
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
303684A randomized, double-blind, placebo-controlled Phase 2A cross-over trial of oral zibotentan in patients with angina due to small vessel disease: a proof-of-concept, developmental trial for safety, efficacy and biomarkers developmentColin BerryMedical Research Council (MRC)MR/S018905/1CAMS - Cardiovascular Science