Author + information
- Received May 10, 2019
- Revision received June 7, 2019
- Accepted June 18, 2019
- Published online October 7, 2019.
- Georg Goliasch, MD, PhDa,∗,
- Max-Paul Winter, MDa,∗,
- Mohamed Ayoub, MDb,
- Philipp E. Bartko, MD, PhDa,
- Catherine Gebhard, MD, PhDa,
- Kambis Mashayekhi, MDb,
- Miroslaw Ferenc, MDb,
- Heinz Joachim Buettner, MDb,
- Christian Hengstenberg, MDa,
- Franz-Josef Neumann, MDb and
- Aurel Toma, MDa,∗ ()
- 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.
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.
↵∗ 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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