Periprocedural cardiac enzyme rise occurred in 34% of hybrid CTO PCI cases but was not associated with higher longer-term MACE compared to patients without enzyme rise (9.3% vs. 8.1%; P=0.60).
Cohort (n=469)
Absolute Event Rate: 9.3% vs 8.1%
p-value: p=0.60
OBJECTIVES: We examined the incidence of periprocedural cardiac enzyme rise (PCER) troponin T (TnT) or high-sensivity (hs)TnT >5× the upper limit of normal (ULN) and periprocedural myocardial infarction (PMI), predictors of PCER and impact of PCER on the longer-term major adverse cardiac events (MACE) following hybrid chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: PCER and PMI after CTO PCI, risk factors for PCER and its impact on longer-term MACE are not fully understood. METHODS: Among 469 CTO PCI cases performed between 01/2010 and 12/2015, next-day TnT or hsTnT was measured in 455 (97%). We examined the incidence of PCER and PMI (with clinical context or TnT ≥70× ULN). In 269 successful cases who had TnT measured, longer-term MACE (death, MI or target-vessel revascularisation/re-occlusion) were assessed. RESULTS: Overall, 420 CTOs (92.3%) were treated successfully. PCER was documented in 34%, while PMI in 2.9%. By multivariable analyses, higher J-CTO score (OR = 1.3 per point; P = 0.002), lower creatinine clearance (OR = 1.01 per each cc/min decrease; P < 0.0001) and recent MI (OR = 2.4; P = 0.007) were independent pre-PCI risk factors for PCER. Among procedural variables, retrograde approach (OR = 1.9; P = 0.014) and procedure duration (OR = 1.2 per 30 min; P = 0.007) were associated with PCER. At a median follow-up of 396 days following successful CTO PCI, PCER was not associated with higher MACE (9.3% vs. 8.1%; P = 0.60), and was not a predictor of MACE in multivariable analysis. CONCLUSIONS: PCER following hybrid CTO PCI is detected in 1/3 of patients. However, true PMI occurs in 2.9%. PCER does not predict adverse long-term outcomes.
Dautov et al. (Mon,) conducted a cohort in Chronic total occlusion (n=469). Hybrid chronic total occlusion percutaneous coronary intervention vs. No periprocedural cardiac enzyme rise was evaluated on Longer-term MACE (death, MI or target-vessel revascularisation/re-occlusion) (p=0.60). Periprocedural cardiac enzyme rise occurred in 34% of hybrid CTO PCI cases but was not associated with higher longer-term MACE compared to patients without enzyme rise (9.3% vs. 8.1%; P=0.60).
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