Author + information
- Jin-Ho Kim1,
- Byeong-Keuk Kim2,
- Chul-Min Ahn3,
- Jung-Sun Kim4,
- Young-Guk Ko5,
- Donghoon Choi2,
- Myeong-Ki Hong2 and
- Yangsoo Jang2
- 1Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Chungbuk, Korea, Republic of
- 2Division of Cardiology, Departments of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of
- 3Division of Cardiology, Departments of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, seoul, Korea, Republic of
- 4Yonsei University College of Medicine, Seoul, Korea, Republic of
- 5Divisions of Cardiology, Departments of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea, Republic of
Limited data exists on the clinical implications of periprocedural myocardial infarction (PMI) after chronic total occlusion (CTO) intervention in the new-generation drug-eluting stents (DESs) era. This study aimed to examine predicting factors, and clinical outcomes of PMI after CTO intervention.
We finally enrolled 337 patients who underwent CTO intervention and met the study criteria. We evaluated the incidence of PMI, defined as creatine kinase-MB increase ≥3x the upper normal limit after intervention and compared the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of cardiac death, myocardial infarction, stent thrombosis, target-vessel revascularization, or cerebrovascular accidents, between the PMI and non-PMI groups.
PMI occurred in 23 patients (6.8%) after CTO intervention. The independent predictors for PMI were previous bypass surgery (OR=5.52, 95%CI=1.17–25.92; p=0.03), Japan-CTO score ≥3 (OR=7.06, 95%CI=2.57–19.39; p<0.001), side branch occlusion on final angiogram (OR=4.21, 95%CI=1.13–15.66; p=0.03), and longer total procedure time (OR=4.18, 95%CI=1.35–12.99; p=0.01). During follow-up (median 29.6 months), the PMI group showed a significantly higher MACCE rate than the non-PMI group (23.7% vs. 5.6%; p=0.008, log-rank test). PMI was an independent predictor of MACCE (HR=4.11, 95%CI=1.30–12.91; p=0.01). MACCE rate gradually increased depending on the peak CK-MB level and was the highest in patients with ≥10xUNL (p=0.005).
Previous bypass surgery, high Japan-CTO score, side branch occlusion, and longer procedure time were strongly related to the occurrence of PMI after CTO intervention. PMI was significantly associated with worse clinical outcomes in new-generation DESs era.
CORONARY: PCI Outcomes