{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:50:17Z","timestamp":1791395417429,"version":"4.3.3"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T00:00:00Z","timestamp":1768089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T00:00:00Z","timestamp":1768089600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The safety and efficacy of protamine reversal of heparin anticoagulation during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown.<\/jats:p>\n                    <jats:p>To outline the indications for and outcomes of protamine administration during CTO PCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter registry of consecutive patients who underwent CTO PCI between January 2019 and March 2025 at five centers and received protamine. Patients were stratified into bailout (for perforation or access\u2010site bleeding) and non\u2010bailout cohorts. The primary endpoint was major adverse cardiovascular events (all\u2010cause death, myocardial infarction, target vessel revascularization, and pericardiocentesis). Outcomes were reported descriptively by indication for protamine use, without formal comparative analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2345 CTO PCI procedures, 672 patients (28.7%) received protamine, including 179 in the bailout cohort and 493 in the non\u2010bailout cohort. The mean J\u2010CTO score was 3.0\u2009\u00b1\u20091.3 in the bailout cohort and 2.6\u2009\u00b1\u20091.2 in the non\u2010bailout cohort. Retrograde strategies were used in 31.8% of the bailout cohort and 19.3% of the non\u2010bailout cohort. Overall, there were 126 coronary perforations observed (6.1%), of which 10 cases (0.5%) required pericardiocentesis. In\u2010hospital major adverse cardiovascular events occurred in 20 patients (11.2%) in the bailout cohort and in 10 patients (2.0%) in the non\u2010bailout cohort (reported descriptively without comparative inference). Across both cohorts, there were no reported cases of stent thrombosis or anaphylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Protamine use during CTO PCI was variably applied across centers and was associated with acceptable in\u2010hospital outcomes; however, the lack of a non\u2010protamine comparison group limits any inference regarding safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70472","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T04:51:04Z","timestamp":1768193464000},"page":"1254-1266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Protamine Use During Chronic Total Occlusion Percutaneous Coronary Intervention: A Multicenter Registry"],"prefix":"10.1002","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5294-3682","authenticated-orcid":false,"given":"Sant","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA"},{"name":"Department of Cardiology Creighton University School of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohaib S.","family":"Roomi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Wellspan Health York Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janelle","family":"Muuse","sequence":"additional","affiliation":[{"name":"The Christ Hospital Heart and Vascular Institute Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Wong","sequence":"additional","affiliation":[{"name":"The Christ Hospital Heart and Vascular Institute Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Boudreau","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Mass General Brigham Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Jamil","sequence":"additional","affiliation":[{"name":"Virginia Heart Inova Schar Heart and Vascular Institute Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen E.","family":"Kearney","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farouc","family":"Jaffer","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Mass General Brigham Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrod","family":"Frizzell","sequence":"additional","affiliation":[{"name":"The Christ Hospital Heart and Vascular Institute Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Cilia","sequence":"additional","affiliation":[{"name":"Virginia Heart Inova Schar Heart and Vascular Institute Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhian E.","family":"Davies","sequence":"additional","affiliation":[{"name":"Division of Cardiology Wellspan Health York Pennsylvania 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