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Systematic biomarker measurement aided in predicting periprocedural injury in CTO PCI
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Systematically measuring cardiac biomarkers in a cohort of patients receiving PCI for chronic total occlusion revealed a periprocedural myocardial injury rate of nearly 10%.
The aim of the study was to evaluate PCI in CTO to determine the incidence, correlates and clinical implications of periprocedural myocardial injury in 325 consecutive patients. The investigators suggested that this type of injury may be underestimated in published findings due to failure to perform these measurements.
Patients treated at a single institution between 2005 and 2012 were eligible for analysis.
Clinicians measured creatine kinase-myocardial band fraction and troponin before PCI between both 8 and 12 hours after procedure and 18 and 24 hours after procedure in the entire patient population.
Creatine kinase-myocardial band increase of at least three times the upper limit of normal served as the definition of periprocedural myocardial injury.
The researchers evaluated patients for MACE at mid-term follow-up. The median follow-up was 2.3 years. The mean patient age was 64 ± 8 years.
Clinicians employed the retrograde approach in 26.8% of procedures.
Results indicated a technical success rate of 77.8% and a procedural success rate of 76.6%.
Twenty-eight patients experienced periprocedural myocardial injury (8.6%; 95% CI, 5.8-12.2). Seven of those patients demonstrated symptomatic ischemia.
The retrograde approach was associated with a 13.8% rate of periprocedural myocardial injury compared with a 6.7% rate among those receiving the antegrade approach (P=.04).
At the median follow-up, patients with periprocedural myocardial injury had an increased incidence of MACE compared with those who did not have injury (HR=2.25; P=.006). This trend held among individuals with only asymptomatic injury (HR=2.26; P=.013).
Disclosure: The researchers report financial relationships with Abbott Vascular, Asahi, Boston Scientific, Covidien, Gilead, Guerbet, HygeiaTel, Janssen Pharmaceuticals, Johnson & Johnson, Mdcareglobal, Medtronic, Sanofi-Aventis and Terumo.
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