{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:02:28Z","timestamp":1784721748952,"version":"3.55.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,6,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Coronary perforation is a life\u2010threatening complication of acute percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), but data on midterm outcomes are limited.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Data from LATAM (Latin American)\u2010CTO Registry (57 centers; 9 countries) were analyzed. We assessed the risk of 30\u2010day, 1\u2010year major adverse cardiac events of coronary perforation using time\u2010to\u2010event and weighted composite end point analysis having CTO PCI without perforation as comparators. Additionally, we studied the independent predictors of perforation in these patients. Of 2054 patients who underwent CTO PCI between 2015 and 2018, the median Multicenter CTO Registry in Japan and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention\u2010Chronic total occlusions scores were 2.0 (1.0\u20133.0) and 1.0 (0.0\u20132.0), respectively. The perforation rate was 3.7%, of which 55% were Ellis class 1. After 1\u2010year coronary perforation had higher major adverse cardiac events rates (24.9% versus 13.3%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Using weighted composite end point, perforation was associated with increased bleeding and ischemic events at 6\u00a0months (\n              <jats:italic>P<\/jats:italic>\n              =0.04) and 1\u00a0year (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). We found as independent predictors associated with coronary perforation during CTO PCI: maximum activated clotting time (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), Multicenter CTO Registry in Japan score \u22652 (\n              <jats:italic>P<\/jats:italic>\n              =0.05), antegrade knuckle wire (\n              <jats:italic>P<\/jats:italic>\n              =0.04), and right coronary artery CTO PCI (\n              <jats:italic>P<\/jats:italic>\n              =0.05).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Coronary perforation was infrequent and associated with anatomical and procedural complexity, resulting in higher risk of hemorrhagic and ischemic events. Landmark and weighted analysis showed a sustained burden of major events between 6\u00a0months and 1\u00a0year follow\u2010up.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.024815","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T10:38:29Z","timestamp":1654252709000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Risk Burden of Coronary Perforation in Chronic Total Occlusion Recanalization: Latin American CTO Registry Analysis"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4458-6835","authenticated-orcid":false,"given":"Marcelo Harada","family":"Ribeiro","sequence":"first","affiliation":[{"name":"Heart Institute (InCor)Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1734-6924","authenticated-orcid":false,"given":"Carlos M.","family":"Campos","sequence":"additional","affiliation":[{"name":"Heart Institute (InCor)Universidade de S\u00e3o Paulo (USP) S\u00e3o Paulo Brazil"},{"name":"Instituto Prevent Senior, Sao Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucio","family":"Padilla","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Carlos B.","family":"da Silva","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division Hospital S\u00e3o Jos\u00e9 do Ava\u00ed, Itaperuna Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5284-9183","authenticated-orcid":false,"given":"Jo\u00e3o Eduardo T.","family":"de Paula","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division Instituto Cardiovascular de Linhares UNICOR Linhares Esp\u00edrito Santo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alcantara","sequence":"additional","affiliation":[{"name":"Centro M\u00e9dico Nacional 20 de Noviembre ISSSTE System Mexico City M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Santiago","sequence":"additional","affiliation":[{"name":"Bayamon Heart &amp; Lung Institute San Juan Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3386-9207","authenticated-orcid":false,"given":"Franklin","family":"Hanna","sequence":"additional","affiliation":[{"name":"Clinica Confamiliar Pereira Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franciele R.","family":"da Silva","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Division Instituto de Cardiologia do Rio Grande do Sul Porto Alegre 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