Periprocedural myocardial injury was associated with increased all-cause mortality after antegrade CTO PCI (HR 1.39; 95% CI 1.02-1.88; p=0.04), but not after retrograde procedures.
Cohort (n=1,909)
Does the prognostic impact of periprocedural myocardial injury on all-cause mortality differ between antegrade and retrograde crossing techniques in patients undergoing CTO PCI?
Periprocedural myocardial injury is associated with increased all-cause mortality following antegrade, but not retrograde, CTO PCI.
Hazard Ratio: 1.39 (95% CI 1.02–1.88)
p-value: p=0.04
AIMS: Periprocedural myocardial injury (PMI) is frequently observed after percutaneous coronary interventions (PCI) for chronic total occlusion (CTO). We aimed to investigate the prognostic impact of PMI with the antegrade as compared to the retrograde crossing technique. METHODS AND RESULTS: A total of 1,909 patients undergoing CTO PCI were stratified according to the presence/absence of PMI (elevation of cardiac troponin T cTnT >5x99th percentile of normal), and divided according to tertiles of the difference between peak and baseline cTnT within 24 hours (∆cTnT). The primary endpoint was all-cause mortality at a median follow-up of 3.1 (interquartile range 3.0-4.4) years. PMI occurred in 19.4% and 25.4% after antegrade (n=1,447) and retrograde (n=462) procedures (p<0.001). PMI was significantly associated with mortality after antegrade (adjusted HR 1.39, 95% CI: 1.02-1.88, p=0.04), but not retrograde CTO PCI (adjusted HR 0.93, 95% CI: 0.53-1.63, p=0.80, pint=0.02). With the antegrade, but not with the retrograde approach, mortality also increased with tertiles of ∆cTnT (T1: 11.0%, T2: 18.6%, T3: 21.6%, log-rank p<0.001). CONCLUSIONS: Periprocedural myocardial injury was significantly associated with all-cause mortality following antegrade, but not retrograde CTO PCI. Hence, the higher risk of PMI following retrograde procedures did not translate into worse survival.
Toma et al. (Sun,) conducted a cohort in chronic total occlusion (n=1,909). Periprocedural myocardial injury (PMI) vs. Absence of PMI was evaluated on all-cause mortality (HR 1.39, 95% CI 1.02-1.88, p=0.04). Periprocedural myocardial injury was associated with increased all-cause mortality after antegrade CTO PCI (HR 1.39; 95% CI 1.02-1.88; p=0.04), but not after retrograde procedures.