Using epicardial CCs for retrograde approach of CTO PCI is effective. Complication rate was acceptable. We found four independent predictors relative to procedure success.

ObjectiveTo 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).BackgroundData regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce.MethodsWe 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.ResultsCP 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).ConclusionsRetrograde 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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