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Incidence, predictors and longer‐term impact of troponin elevation following hybrid chronic total occlusion percutaneous coronary intervention
Author(s) -
Dautov Rustem,
Ybarra Luiz Fernando,
Nguyen Can Manh,
Gibrat Claire,
Joyal Dominique,
Rinfret Stéphane
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27545
Subject(s) - medicine , mace , conventional pci , percutaneous coronary intervention , cardiology , myocardial infarction , troponin t , coronary occlusion , troponin , context (archaeology) , incidence (geometry) , paleontology , physics , optics , biology
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.