A Contemporary Definition of Periprocedural Myocardial Injury After Percutaneous Coronary Intervention of Chronic Total Occlusions

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

doi:10.1016/j.jcin.2019.06.053

JACC: Cardiovascular Interventions

Volume 12, Issue 19, October 2019 DOI: 10.1016/j.jcin.2019.06.053

A Contemporary Definition of Periprocedural Myocardial Injury After Percutaneous Coronary Intervention of Chronic Total Occlusions

Georg Goliasch, Max-Paul Winter, Mohamed Ayoub, Philipp E. Bartko, Catherine Gebhard, Kambis Mashayekhi, Miroslaw Ferenc, Heinz Joachim Buettner, Christian Hengstenberg, Franz-Josef Neumann and Aurel Toma

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Author + information

vol. 12 no. 19 1915-1923

DOI:

https://doi.org/10.1016/j.jcin.2019.06.053

Published By:

JACC: Cardiovascular Interventions

Print ISSN:

1936-8798

Online ISSN:

1876-7605

History:

Received May 10, 2019
Revision received June 7, 2019
Accepted June 18, 2019
Published online October 7, 2019.

2019 American College of Cardiology Foundation

Author Information

Georg Goliasch, MD, PhD^a,^∗,
Max-Paul Winter, MD^a,^∗,
Mohamed Ayoub, MD^b,
Philipp E. Bartko, MD, PhD^a,
Catherine Gebhard, MD, PhD^a,
Kambis Mashayekhi, MD^b,
Miroslaw Ferenc, MD^b,
Heinz Joachim Buettner, MD^b,
Christian Hengstenberg, MD^a,
Franz-Josef Neumann, MD^b and
Aurel Toma, MD^a,^∗ (aurel.toma{at}meduniwien.ac.at)

^aDepartment of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
^bDivision of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany

↵∗Address for correspondence:
Dr. Aurel Toma, Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Central Illustration

Abstract

Objectives The 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.

Background Coronary 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.

Methods A 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.

Results Using 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.

Conclusions This 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.

Key Words

Footnotes

↵∗ Drs. Goliasch and Winter contributed equally to this work.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Received May 10, 2019.
Revision received June 7, 2019.
Accepted June 18, 2019.

2019 American College of Cardiology Foundation

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