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.