Protamine Use During Chronic Total Occlusion Percutaneous Coronary Intervention: A Multicenter Registry.

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Medicine

Background:

• The role of protamine in reversing heparin anticoagulation during complex percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains unclear.
• Understanding protamine's indications and outcomes in CTO PCI is crucial for patient safety.

Purpose of the Study:

• To evaluate the indications for and in-hospital outcomes of protamine administration in patients undergoing CTO PCI.
• To assess the safety profile of protamine in this specific patient population.

Main Methods:

• A multicenter registry included patients undergoing CTO PCI between January 2019 and March 2025 who received protamine.
• Patients were categorized into bailout (for complications) and non-bailout groups.
• The primary endpoint was major adverse cardiovascular events; outcomes were reported descriptively.

Main Results:

• Of 2345 CTO PCI procedures, 672 patients received protamine.
• In-hospital major adverse cardiovascular events were 11.2% in the bailout cohort and 2.0% in the non-bailout cohort.
• No cases of stent thrombosis or anaphylaxis were reported.

Conclusions:

• Protamine use in CTO PCI was inconsistently applied across centers.
• The observed in-hospital outcomes were acceptable, but a lack of a non-protamine comparison group restricts definitive safety inferences.
• Further research with comparative analysis is needed to establish the true safety and efficacy of protamine in CTO PCI.