Determinants and prognostic implication of periprocedural myocardial injury after successful recanalization of coronary chronic total occlusion

Santos, Luís Graça; Delgado-Silva, Joana; Soares, Fabiana; Paiva, Luís; Costa, Marco; Neves, C. Susanna; Jorge, Elisabete; Gonçalves, Lino

doi:10.1007/s12928-020-00727-6

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…The European Society of Cardiology (ESC) expert consensus in 2021 adopted cTn elevation greater than 5 times the upper limit of the 99% reference value after PCI as the universal definition of PMI [ 3 ], increasing centers started to adopt this definition for PMI-related studies. Using elevated cTn as the definition of PMI, Graca-Santos et al showed that the occurrence of PMI after CTO-PCI was associated with the occurrence of MACE within 1 year [ 26 ]. Similarly, a meta-analysis showed the same results that patients with PMI had a higher incidence of MACE [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Kong

Dai

Luan

et al. 2022

BMC Cardiovasc Disord

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Background Periprocedural myocardial injury (PMI) is associated with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). However, the incidence predictors and prognosis of PMI in chronic total occlusion (CTO) undergoing PCI remains unclear. Method To evaluate the predictors and prognostic impact of PMI following PCI in patients with CTO. We consecutively enrolled 132 individuals and 8 of whom with procedural failure were excluded in this study. Thus, a total of 124 CTO patients successfully received PCI were included in this study. And patients were divided into the PMI group (n = 42) and the non-PMI group (n = 82) according to their c-TnI levels measured after procedure. The baseline and angiographic characteristics of the two groups were compared. The predictors of PMI and the correlation between PMI and MACE were investigated. Results Overall, PMI occurred in 42 patients (33.9%). Comparing with control group, PMI group had more diabetes (54.8% vs. 31.7%,P = 0.013) and dyslipidemia (54.8% vs. 13.4%, P＜0.001). Also, there were significant differences between the two groups in left ventricular ejection fraction(43.2 ± 7.2 vs 47.2 ± 8.0, P = 0.027), prior myocardial infarction(54.8%vs43.1%, P = 0.020), prior PCI(57.1% vs 22.0%, P＜0.001) and prior CABG(14.3% vs 2.4%, P = 0.011). Also, patients with PMI had more calcified lesions (52.4% vs 24.4%, P = 0.002) and were more likely to have multivessel disease (71.4% vs 35.4%, P＜0.001). In addition, patients in the PMI group had higher J-CTO scores (3.3 ± 1.0 vs 1.9 ± 0.5, P＜0.001) and were more likely to have wire-crossing difficulties (64.3% vs 37.8%, P = 0.005), require more use of retrograde approach (38.1% vs 7.3%, P＜0.001) and have more procedural complications (19.0% vs 2.4%, P = 0.003). In the multivariate analysis, multivessel artery disease (odd ratio [OR], 4.347;95% confidence interval [CI], 1.601– 11.809;P = 0.004), retrograde approach (OR, 4.036; 95%CI, 1.162– 14.020;P = 0.028) and the presence of procedural complications (OR, 16.480;95%CI, 2.515-107.987;P = 0.003) were predictors of PMI. Conclusion The incidence of PMI in CTO patients after PCI was 33.9%. Multivessel artery disease, retrograde approach, and the presence of procedural complications were predictors of PMI after CTO-PCI. Patients who develop PMI tend to have a poorer clinical prognosis and more MACE than those who do not develop PMI.

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Section: Discussionmentioning

confidence: 99%

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Kong

Dai

Luan

et al. 2022

BMC Cardiovasc Disord

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“…23,32 Myocardial injury (defined as hsTnT >5x upper reference limit [URL]) is common during CTO PCI (34%-58%), more frequent with higher complexity anatomy (J-CTO ≥ 3) (Figure 1) or following the retrograde approach. [33][34][35][36] Perforations are often associated with cap and vessel course ambiguity and tortuosity, significant calcification requiring extensive modification, 37 or during collateral crossing. Thus in high complexity CTOs, where there is frequently the need for a second procedure, a strategy of an initial "investment procedure" to resolve the proximal cap and vessel course, then allow healing of hematoma and vessel modification, should increase the proportion of cases that can be completed antegrade, potentially reduce side-branch loss, 38 and result in increased cumulative procedural success and lower complication rates.…”

Section: Study Rationalementioning

confidence: 99%

“…PMI can result from side‐branch loss, hematoma compression, or as a result of reduced perfusion with equipment across the collateral circulation 23,32 . Myocardial injury (defined as hsTnT >5x upper reference limit [URL]) is common during CTO PCI (34%–58%), more frequent with higher complexity anatomy (J‐CTO ≥ 3) (Figure 1) or following the retrograde approach 33–36 . Perforations are often associated with cap and vessel course ambiguity and tortuosity, significant calcification requiring extensive modification, 37 or during collateral crossing.…”

Section: Study Rationalementioning

confidence: 99%

Effectiveness, safety, and patient reported outcomes of a planned investment procedure in higher‐risk chronic total occlusion percutaneous coronary intervention: Rationale and design of the invest‐CTO study

Øksnes,

Skaar,

Engan

et al. 2023

Cathet Cardio Intervent

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Background The anatomical complexity of a chronic total occlusion (CTO) correlates with procedural failure and complication rates. CTO modification after unsuccessful crossing has been associated with subsequent higher technical success rates, but complication rates remain high with this approach. While successful CTO percutaneous coronary intervention (PCI) has been associated with improved angina and quality of life (QOL) this has not been demonstrated in anatomically high‐risk CTOs. Whether a planned CTO modification procedure, hereafter named Investment procedure, could improve patient outcomes has never been investigated. Study Design Invest‐CTO is a prospective, single‐arm, international, multicenter study, evaluating the effectiveness and safety of a planned investment procedure, with a subsequent completion CTO PCI (at 8–12 weeks), in anatomically high‐risk CTOs. We will enroll 200 patients with CTOs defined as high‐risk according to our Invest CTO criteria at centers in Norway and United Kingdom. Patients with aorto‐ostial lesions, occlusion within a previous stent, or a prior attempt at target vessel CTO PCI within 6 months will be excluded. The co‐primary endpoints are cumulative procedural success (%) after both procedures, and a composite safety endpoint at 30 days after completion CTO PCI. Patient reported outcomes (PROs), treatment satisfaction, and clinical endpoints will be reported. Conclusion This study will prospectively evaluate the effectiveness and safety of a planned two staged PCI procedure in the treatment of high‐risk CTOs and may have the potential to change current clinical practice.

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A contemporary review of clinical significances of percutaneous coronary intervention for chronic total occlusions, with some Japanese insights

Morino

2021

Cardiovasc Interv and Ther

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Determinants and prognostic implication of periprocedural myocardial injury after successful recanalization of coronary chronic total occlusion

Cited by 4 publications

References 25 publications

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion

Effectiveness, safety, and patient reported outcomes of a planned investment procedure in higher‐risk chronic total occlusion percutaneous coronary intervention: Rationale and design of the invest‐CTO study

A contemporary review of clinical significances of percutaneous coronary intervention for chronic total occlusions, with some Japanese insights

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