Coronary perforations and its clinical impact during CTO recanalization: a 2054 patients pooled analysis from the Latin American (LATAM) CTO registry

• Published in: European heart journal Vol. 42; no. Supplement_1
• Main Authors: Harada Ribeiro, M, Quadros, A, Padilla, L T, Belli, K C, Piccaro, P, Dallan, L A, Silveira, C E, Quesada, F H, Morales, N, Santiago, R, Mashayekhi, K C, Azzalini, L A, Galassi, A R, Campos, C M
• Format: Journal Article
• Language: English
• Published: 12-10-2021
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehab724.2161

Abstract
Introduction
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) are the most challenging procedures and still associated with the highest complications rates. Coronary perforation is a life-threatening acute PCI complication, but data are limited regarding its impact on mid-term outcome. We aimed to assess 30-days and 1-year outcomes in CTO PCI patients with coronary perforations.
Purpose
Analyze the clinical impact of Cto perforations during CTO PCI at short and mid-term in a muticenter continental registry in Latin America (LATAM).
Methods
We analyzed data from the continental multicenter Latin America CTO Registry including patients who underwent CTO PCI in 57 centers from 9 countries. Coronary perforation during the index procedure were categorized according to Ellis classification. We assessed 30-days adverse events and 1-year major adverse cardiac and cerebrovascular (MACCE) defined as the composite of all-cause death, myocardial infarction (MI), target vessel revascularization and stroke. MI was defined according both the LATAM CTO protocol and SCAI definitions.
Results
From January 2015 to October 2018, 2054 patients underwent CTO PCI. The median J-CTO score was 2.0 (1.0–3.0) and the median Progress score was 1.0 (0.0–2.0). The overall perforation rate was 3.7% (n=76) in which 55% were Ellis class 1, 24% Ellis class 2 and 21% Ellis class 3. No differences were found in any baseline clinical characteristics. Patients with perforation had more frequently retrograde instrumentation (P<0.01) and antegrade knuckle wire (P<0.01) and lower success rate (P<0.01). At 30-days, perforations were associated with more heart failure (6.6% vs 1.5%, p<0.01), bleeding (15.2% vs 3.7%, p<0.01), transfusion (7.9% vs 1.1%, p<0.01) and cardiac tamponade (13.2% vs 0.4%, p<0.01). After 1-year follow-up, patients with perforations had higher MACCE rates according to both LATAM CTO protocol (18.2 vs. 9.4%; P=0.02) and SCAI definitions (22.7% vs. 11.3%; P<0.01).
Conclusions
In this multicenter continental real-world analysis, coronary perforation in CTO PCI was infrequent and was related with higher anatomical and procedural complexity characteristics. Despite the similarity in clinical characteristics, patients that had coronary perforation were exposed to an increased risk of both hemorrhagic and ischemic events.
Funding Acknowledgement
Type of funding sources: None.