Association of Periprocedural Myocardial Infarction With Long-Term Survival in Patients Treated With Coronary Revascularization Therapy of Chronic Total Occlusion

Objective: To evaluate the impact of periprocedural myocardial infarction (PMI) on long-term survival after coronary revascularization in patients with chronic total occlusion (CTO). Background: Little is known about the clinical impact of PMI on long-term cardiac mortality after CTO revascularization in patients with stable angina. Methods: We analyzed data from 927 patients with CTO and stable angina who were treated with coronary artery bypass grafting (CABG, n=367) or percutaneous coronary intervention (PCI, n=560). PMI was defined as a peak CK-MB >= 3 times the upper limit of normal (ULN) after PCI or a CK-MB >= 5 times the ULN after CABG. The primary outcome was cardiac death in patients with PMI (PMI group, n=118 [12.7%]) or without PMI (no-PMI group, n=809 [87.3%]) after revascularization. Results: During a median follow-up of 42 months, PMI occurred in 118 patients (12.7% of the overall study population). Fifty-nine patients treated with PCI (10.5% of PCI subgroup) and 59 patients treated with CABG (16.1% of CABG subgroup) suffered from PMI. In multivariate analysis, the PMI group and the no-PMI group had a similar incidence of cardiac death (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.20 to 1.62; P=0.29). Conclusions: PMI may not be associated with increased cardiac mortality after coronary revascularization in patients with stable CTO. (C) 2015 Wiley Periodicals, Inc.