A Contemporary Definition of Periprocedural Myocardial Injury After Percutaneous Coronary Intervention of Chronic Total Occlusions
Clinical question: At what point does the post-procedural troponin T increase in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) drives mortality?
What was already known: To date, current guidelines recommend identifying those patients undergoing CTO-PCI at higher risk for peri- and post-interventional complications, according to periprocedural cardiac biomarker thresholds that are arbitrarily chosen and not grounded on scientific evidence.
Methods: This is a prospective observational study that included consecutive patients undergoing CTO-PCI in a US tertiary center. Blood draws were taken at baseline and at 6, 8, and 24 h after the procedure, and troponin levels were measured at each time point. The primary endpoint was defined as all-cause mortality during 5-year follow-up. As secondary study endpoint, we defined a composite endpoint comprising death, nonfatal myocardial infarction, and target lesion vessel revascularization.
Results/Implications: They included 3,712 patients undergoing CTO PCI in this analysis. During a median follow-up period of 2 years (IQR: 1 to 3 years), 335 patients died. There was a significant association between post-procedural troponin and long-term outcomes in the Cox regression analysis (p < 0.001).
Bottom line: In patients undergoing CTO-PCI, they defined biomarker thresholds for procedure-related myocardial injury using stringent statistical methodology that may help guide post-procedural clinical care in this high-risk patient population.