慢性完全閉塞経皮的冠動脈形成術手技における冠動脈穿孔に対するプロタミン利用と臨床転帰

Limited evidence exists for the management of coronary artery perforation. We evaluated temporal trends and clinical outcomes associated with protamine use following coronary artery perforation in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs).

A single-center retrospective analysis was performed on coronary perforations in patients undergoing CTO PCI procedures between September 10, 2014, and December 31, 2018, encompassing a change in institutional practice regarding use of protamine at case conclusion. The primary outcome was a composite of in-hospital mortality and cardiac tamponade. Multivariate logistic regression analyses were used to assess the association between protamine use and clinical outcomes.

In total, 1454 patients undergoing CTO PCI, coronary perforation occurred in 160 (11.0%), of which 68 (42.5%) received protamine. Ellis perforation classification was similar in the protamine and non-protamine groups (P = .148). The primary outcome of in-hospital mortality or cardiac tamponade occurred less frequently in the protamine group compared with the nonprotamine group (11.8% vs 40.2%; P < .01). In-hospital mortality (1.5% vs 14.1%; P = .01) and cardiac tamponade (10.3% vs 26.1%; P = .02) occurred less frequently in the protamine group. In a multivariate logistic regression, protamine was independently associated with an improved primary outcome (OR, 0.27; 95% CI, 0.10-0.65; P < .01).

In this retrospective analysis, use of protamine in patients with coronary artery perforation complicating CTO PCI was associated with a reduction in death and cardiac tamponade without evidence of increased stent thrombosis. Additional studies are warranted to establish optimal strategies for protamine use.