Key result
Coronary perforation during retrograde CTO PCI through epicardial collaterals was not significantly associated with worse long-term major adverse cardiac events (HR 1.55; 95% CI 0.45-5.32; P=0.484).
Why the study?
Data regarding coronary perforation during retrograde PCI through epicardial collaterals for chronic total occlusion were scarce.
What are the predictors of coronary perforation during retrograde CTO PCI via epicardial collaterals, and does it impact long-term MACE?
Cohort (n=155)
No
What are the predictors of coronary perforation during retrograde CTO PCI via epicardial collaterals, and does it impact long-term MACE?
Hazard Ratio: 1.55 (95% CI 0.45–5.32)
p-value: p=0.484
Coronary perforation is a common complication of retrograde CTO PCI via epicardial collaterals, predicted by renal dysfunction, RCA CTO, and Epi-CTO score ≥ 2, but does not significantly worsen long-term outcomes when promptly managed.
CP risk elevated in epicardial retrograde CTO PCI with renal dysfunction or RCA target; leaves open validation of predictors in prospective studies.
OBJECTIVE: To investigate predictors, treatment, and long-term outcomes associated with coronary perforation (CP) in patients who underwent retrograde percutaneous coronary intervention (PCI) through epicardial collaterals for chronic total occlusion (CTO). BACKGROUND: Data regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce. METHODS: We included 155 patients who underwent retrograde CTO PCI through epicardial collaterals at Guangdong Cardiovascular Institute from August 2011 to December 2017. The median follow-up was 2.5 years. Major adverse cardiac events (MACEs) were analyzed using the Kaplan-Meier method, and independent predictors of long-term MACE were determined using a multivariable Cox model. RESULTS: CP occurred in 24 (15.5%) patients, with the frequency of Ellis classes 1 or 2 and 3 being 41.7% and 58.3%, respectively. Seven (4.5%) patients had tamponade, which was effectively managed using coil embolization and pericardiocentesis. Renal dysfunction (odds ratio [OR]: 5.27; 95% confidence interval [CI]: 1.47-18.88; P = 0.011), right coronary artery (RCA) CTO (OR: 4.34; 95% CI: 1.29-14.63; P = 0.018), and Epi-CTO score ≥ 2 (OR: 3.27; 95% CI: 1.12-9.58; P = 0.030) were independent predictors of CP. At the 7-year follow-up, 17 patients had MACE. Multivariable analysis revealed that CP was not associated with worse long-term clinical outcomes (hazard ratio: 1.55; 95% CI: 0.45-5.32, P = 0.484). CONCLUSIONS: Retrograde CTO PCI through epicardial collaterals is at increased risk of CP, which is associated with renal dysfunction, RCA CTO, and Epi-CTO score ≥ 2. Prompt and proper management of CP is important. CP is not significantly associated with adverse clinical outcomes.
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Wu et al. (2019) conducted a cohort in Chronic total occlusion (CTO) (n=155). Coronary perforation vs. No coronary perforation was evaluated on Long-term major adverse cardiac events (MACE) (HR 1.55, 95% CI 0.45-5.32, p=0.484). Coronary perforation during retrograde CTO PCI through epicardial collaterals was not significantly associated with worse long-term major adverse cardiac events (HR 1.55; 95% CI 0.45-5.32; P=0.484).
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