Incidence, predictors and longer‐term impact of troponin elevation following hybrid chronic total occlusion percutaneous coronary intervention

Authors:
Publisher website
Google Scholar
Abstract
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.

This publication has 19 references indexed in Scilit: