Determinants and Prognostic Significance of Periprocedural Myocardial Injury in Patients With Successful Percutaneous Chronic Total Occlusion Interventions

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• 作者：Seung-Whan Lee ; MD ; PhD ; Pil H. Lee ; MD ; Se H. Kang ; MD ; Hanul Choi ; MD ; Mineok Chang ; MD ; Jae-Hyung Roh ; MD ; Sung-Han Yoon ; MD ; Jung-Min Ahn ; MD ; Duk-Woo Park ; MD ; PhD ; Soo-Jin Kang ; MD ; PhD ; Young-Hak Kim ; MD ; PhD ; Cheol Whan Lee ; MD ; PhD ; Seong-Wook Park ; MD ; PhD ; Seung-Jung Park ; MD ; PhD ; ^{sjpark@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：chronic total occlusion ; drug-eluting stent ; periprocedural myocardial injury ; prognosis ; retrograde
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：14 November 2016
• 年：2016
• 卷：9
• 期：21
• 页码：2220-2228
• 全文大小：797 K

文摘

This study sought to evaluate the determinants and prognostic implications of periprocedural myocardial injury (PMI) in successful percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs).

Background

There are limited studies addressing the risk factors and clinical implication of PMI in patients undergoing CTO-PCI.

Methods

We examined 1,058 consecutive CTO patients who underwent successful drug-eluting stent implantation and serial measurements of creatine kinase-myocardial band (CK-MB) values between March 2003 and August 2014. PMI was defined as elevations of CK-MB >3 times the upper reference limit (URL).

Results

PMI occurred in 121 patients (11.4%). Multivariable analysis revealed that the presence of renal failure (odds ratio [OR]: 4.25; 95% confidence interval [CI]: 1.59 to 11.35; p = 0.004), attempted retrograde approach (OR: 2.27; 95% CI: 1.34 to 3.84; p = 0.002), concomitant non–target lesion intervention (OR: 1.74; 95% CI: 1.17 to 2.59; p = 0.006), and stent number (OR: 1.38; 95% CI: 1.08 to 1.77; p = 0.011) were predictors associated with PMI. During a median follow-up of 4.4 years, PMI was associated with an increased risk of mortality (adjusted hazard ratio: 1.86; 95% CI: 1.09 to 3.17; p = 0.02). These findings were also consistent when higher CK-MB cutoff was used to define PMI. Although there was a trend toward higher all-cause mortality with increasing peak CK-MB levels, in multivariable analyses, this association was statistically significant only for peak CK-MB levels of >10 times the URL.

Conclusions

PMI was associated with an increased risk of long-term mortality after successful CTO-PCI. Patients with renal insufficiency, those who require more stents, multiple lesion treatment, and retrograde approach have a higher likelihood of having PMI.