Clinical outcomes and risk factors of periprocedural myocardial injury after successful percutaneous coronary intervention for chronic total occlusions

Limited published data about periprocedural myocardial injury (PMI) after successful chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) were available. The study aimed to investigate risk predictors and clinical implications of PMI after successful CTO-PCI and drug-eluting stent (DES) implantation. Between 2009and 2012, a total of 437 patients who underwent successful recanalization with DESs were included. All the cardiac troponin T (cTnT)-positive patients were excluded. As the benchmark in PMI defined as cTnT >5 x the 99th percentile ULN, the independent predictors and major adverse cardiac events (MACEs) involving cardiac death, myocardial infarction, and target-vessel revascularization were compared between the PMI group and the no PMI group. The incidence rate of PMI was 18.3% (80/437) after the index procedure. Multivariate analysis showed that calcification (OR: 2.203, confidence interval [CI] 1.262-3.845, P = 0.005), the parallel wire technique (OR: 3.178, CI 1.661-6.081, P < 0.001), and the retrograde wire technique (OR: 5.554, CI 2.275-13.558, P < 0.001) were independent predictors of PMI after successful CTO-PCI and DES implantation. Major adverse cardiac events were significantly higher in the PMI group (adjusted hazard ratio 3.704; 95% CI 1.759-7.796; P = 0.001) during the 3-year follow-up. The independent predictors of PMI after successful recanalization with DESs are calcification, the parallel wire technique, and the retrograde wire technique. Periprocedural myocardial injury after the index procedure is associated with more adverse clinical events. Further large clinical studies combined with bioinformatics are warranted to explore the implications of patients with this distinct new entity.