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

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Abstract

Periprocedural myocardial injury (PMI) has been generally associated with major adverse cardiac events (MACE), however, limited studies addressed its clinical implications following chronic total occlusion (CTO) percutaneous coronary intervention (PCI). To evaluate the determinants and prognostic implication of PMI following CTO-PCI. Retrospective single-centre study of 125 consecutive patients undergoing CTO-PCI was attempted between December 2013 and December 2017. Angiographic success was achieved in 115 patients (92.0%) and cTn-I values were obtained 12–24 h following PCI. PMI was defined as an elevation of cTn-I above 5 times the 99th-percentile upper reference limit. Baseline demographic, clinical, angiographic and procedural characteristics were compared. Multivariate analysis was performed to determine the predictors of PMI and the correlates of PMI and 1-year MACE, a composite of all-cause death, non-fatal myocardial infarction, and target lesion revascularization. Overall, mean age was 67 ± 17 years; 25 patients (21.7%) were female; and PMI occurred in 41 patients (35.7%). Multivessel coronary artery disease (MVD) (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.09–10.67; p = 0.04) and procedural complications (a composite of iatrogenic coronary artery dissection/haematoma or perforation) (OR, 19.08; 95% CI, 3.77–96.65; p < 0.01) predicted PMI. Significant collateralization (Rentrop 3) (hazard ratio, [HR], 0.19; 95% CI, 0.06–0.64; p < 0.01) and procedural complications (HR, 8.86; 95% CI, 2.66–29.46; p < 0.01) were independently associated with 1-year MACE, while PMI was not (p = 0.26). In this contemporary cohort, PMI following successful CTO-PCI was a common finding and was predicted by MVD and procedural complications. PMI was not independently associated with 1-year MACE.

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Authors

Contributions

Conceptualization: LGS, JDS. Methodology: LGS, JDS, FS. Formal analysis and investigation: LGS, FS, CN. Writing—original draft preparation: LGS. Writing—review and editing: JDS, FS, LP, MC, EJ, LG. Funding acquisition: None. Resources: CN, LG. Supervision: JDS, LP, MC, EJ, LG.

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Correspondence to Luís Graça-Santos.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Coimbra University Hospital Centre given the retrospective nature of the study and all the procedures being performed were part of the routine care.

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All authors whose names appear on the submission. (1) Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Consent from all patients was obtained as part of the routine care (retrospective and observational study).

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Graça-Santos, L., Delgado-Silva, J., Soares, F. et al. Determinants and prognostic implication of periprocedural myocardial injury after successful recanalization of coronary chronic total occlusion. Cardiovasc Interv and Ther 36, 470–480 (2021). https://doi.org/10.1007/s12928-020-00727-6

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  • DOI: https://doi.org/10.1007/s12928-020-00727-6

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