Coronary Artery Perforation During Percutaneous Coronary Intervention: A Two-Center Real-World Case Series and Review of Management Strategies

BACKGROUND: Coronary artery perforation (CAP) is a rare life-threatening complication of percutaneous coronary intervention (PCI). Although several risk factors for CAP have been described, real-world multicenter studies analyzing the clinical outcomes remain limited. This study presents a comprehensive 2-center evaluation of CAP, focusing on angiographic severity, management strategies, and short- and long-term outcomes. METHODS: In this study, patients of CAP were included and perforations were classified according to the Ellis system. Primary outcomes were procedural success, cardiac tamponade, pericardiocentesis, cardiogenic shock, and 30-day mortality. Secondary outcomes were late mortality and ejection fraction at the end of first month. RESULTS: Totally, 53 cases of CAP were identified. Ten patients had Ellis grade I, 30 patients had grade II, and 13 patients had grade III perforations. The rate of successful procedure was 100% in grade I, 90% in grade II, and 30.8% in grade III (P < .001). Hemodynamic compromise was observed predominantly in grade III perforations. Early mortality occurred in 7 patients (13.2%) and was strongly associated with severe Ellis grades (P < .001). Late mortality occurred in 5 patients (9.4%), and chronic renal insufficiency was identified as a significant predictor of mortality (P = .018). Ejection fraction was significantly lower in grade III perforations at the end of first month (P = .005). CONCLUSION: Increasing Ellis grade was strongly associated with procedural failure, hemodynamic instability, and early mortality, whereas late outcomes were predominantly influenced by systemic comorbidities rather than the severity of perforation. These findings underscore the importance of prompt intraprocedural management and comprehensive post-discharge care in patients with CAP.