A Contemporary Definition of Periprocedural Myocardial Injury After Percutaneous Coronary Intervention of Chronic Total Occlusions |
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Authors: | Georg Goliasch Max-Paul Winter Mohamed Ayoub Philipp E. Bartko Catherine Gebhard Kambis Mashayekhi Miroslaw Ferenc Heinz Joachim Buettner Christian Hengstenberg Franz-Josef Neumann Aurel Toma |
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Affiliation: | 1. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria;2. Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany |
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Abstract: | ObjectivesThe aim of this study was to assess the prognostic impact of post-procedural troponin T increase and mortality in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) to define the threshold at which procedure-related myocardial injury drives mortality.BackgroundCoronary CTO recanalization represents the most technically challenging PCI. The complexity harbors a significant increased risk for complications with CTO PCI with compared with non-CTO PCI. However, there are evidenced biomarker cutoff levels that help identify those patients at risk for unfavorable clinical outcomes.MethodsA total of 3,712 consecutive patients undergoing PCI for at least 1 CTO lesion were enrolled, and comprehensive troponin T measurements were performed 6, 8, and 24 h after the procedure. All-cause mortality was defined as the primary study endpoint.ResultsUsing spline curve analysis, a more than 18-fold increase of troponin above the upper reference limit was significantly associated with mortality. In a Cox regression analysis, the crude hazard ratio was 2.32 (95% confidence interval: 1.83 to 2.93; p < 0.001) for a ≥18-fold increase compared with patients with post-procedural troponin increase <18-fold of the upper reference limit. Results remained virtually unchanged after bootstrap- or clinical confounder–based adjustment.ConclusionsThis large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in patients with CTOs. A threshold was defined for procedure-related myocardial injury in patients with CTOs to differentiate them from those without CTOs that may help guide post-procedural clinical care in this high-risk patient population. |
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Keywords: | chronic total occlusion coronary artery disease CTO PCI CABG coronary artery bypass graft CI confidence interval CTO chronic total occlusion HR hazard ratio IQR interquartile range PCI percutaneous coronary intervention PMI periprocedural myocardial injury URL upper reference limit |
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