Incidência, manejo e prognóstico de perfura？？es coronárias

background: coronary perforation is currently a rare, but potentially catastrophic complication. the aim of the study was to evaluate the incidence, predictors, management and prognosis of coronary perforations at a hospital with a large number of percutaneous coronary interventions (pcis). methods: clinical, angiographic, procedural and in-hospital outcomes of patients with or without coronary perforations were compared. univariate analysis was performed to determine the predictors of this complication. results: from december 2007 to january 2012, 5,585 consecutive patients were submitted to pci and 18 had coronary perforation (0.32%), of whom 55.5% were female and 38.9% were diabetic. in this group, the left anterior descending artery was the most frequently treated vessel (61.1%) as well as type c lesion (61.1%) and chronic occlusions were approached in 27.8% of these cases. most of the coronary perforations (11/18) had a lower complexity according to the modified ellis classification, whereas the remaining perforations were classified as grades iii (6/18) or iv (1/18). the balloon-catheter device was responsible for perforation in 61.1% of the cases. prolonged inflation with a balloon-catheter and heparin reversal with protamine was performed in 72.2% and 88.9% of the cases, respectively. only 1 patient (5.6%) required an emergency surgery due to cardiac tamponade. there were no deaths associated with coronary perforation. according to the univariate analysis, coronary perforation predictors were: female gender (p = 0.03), chronic obstructive pulmonary disease (p = 0.006) and chronic occlusion (p < 0.01). conclusions: in our experience, coronary perforation was a rare event, which was managed conservatively in most of the cases and was associated with a good in-hospital outcome.