Objectives: This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO).
Background: The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies.
Methods: We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥ 3 x the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated.
Results: Mean age was 64 ± 8 years. The retrograde approach was used in 26.8% of all procedures. The technical and procedural success was 77.8% and 76.6%, respectively. PMI occurred in 28 patients (8.6%, 95% confidence intervals: 5.8% to 12.2%), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8% vs. 6.7%, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013).
Conclusions: Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6% of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.
Keywords: CABG; CI; CK-MB; CTO; HR; IQR; MACE; MI; OR; PCI; PMI; ULN; acute myocardial infarction; chronic total occlusion; chronic total occlusion(s); complications; confidence interval(s); coronary artery bypass graft; creatine kinase-myocardial band; hazard ratio(s); interquartile range; major adverse cardiac events; myocardial infarction(s); odds ratio(s); percutaneous coronary intervention; percutaneous coronary intervention(s); periprocedural myocardial injury; upper limit of normal.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.