Risk Burden of Coronary Perforation in Chronic Total Occlusion Recanalization: Latin American CTO Registry Analysis.
Marcelo Harada RibeiroCarlos A H de Magalhães CamposLucio PadillaAntonio Carlos B da SilvaJoão Eduardo T de PaulaMarco AlcantaraRicardo SantiagoFranklin HannaFranciele R da SilvaKarlyse Claudino BelliLorenzo AzzaliniPedro P de OliveiraGustavo Neves de AraujoVincenzo SucatoFranz-Josef NeumannAlfredo R GalassiAlexandre Antonio Cunha AbizaidAlexandre Schaan de QuadrosPublished in: Journal of the American Heart Association (2022)
Background Coronary perforation is a life-threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited. Methods and Results Data from LATAM (Latin American)-CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30-day, 1-year major adverse cardiac events of coronary perforation using time-to-event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention-Chronic total occlusions scores were 2.0 (1.0-3.0) and 1.0 (0.0-2.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1-year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%; P <0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6 months ( P =0.04) and 1 year ( P <0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time ( P <0.01), Multicenter CTO Registry in Japan score ≥2 ( P =0.05), antegrade knuckle wire ( P =0.04), and right coronary artery CTO PCI ( P =0.05). Conclusions Coronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6 months and 1 year follow-up.
Keyphrases
- coronary artery disease
- coronary artery
- percutaneous coronary intervention
- acute myocardial infarction
- acute coronary syndrome
- st segment elevation myocardial infarction
- antiplatelet therapy
- st elevation myocardial infarction
- coronary artery bypass grafting
- ejection fraction
- atrial fibrillation
- end stage renal disease
- aortic stenosis
- pulmonary artery
- left ventricular
- newly diagnosed
- randomized controlled trial
- magnetic resonance
- emergency department
- type diabetes
- patient reported outcomes
- magnetic resonance imaging
- adipose tissue
- metabolic syndrome
- blood brain barrier
- cross sectional
- pulmonary hypertension
- deep learning
- electronic health record
- machine learning
- drug induced
- weight loss
- clinical trial