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ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) Pulmonary Hypertension Caused by a Coconut Left Atrium Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk New Volumetric Analysis Method for Stent Expansion and its Correlation With Final Fractional Flow Reserve and Clinical Outcome An ILUMIEN I Substudy Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW 2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients 中国肺动脉高压诊断与治疗指南（2021版） Plaque Rupture, compared to Plaque Erosion, is associated with Higher Level of Pan-coronary Inflammation
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Clinical TrialPublished on 26 September 2017

JOURNAL：EuroIntervention. Article Link

Clinical Implications of Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion: Role of Antegrade and Retrograde Crossing Techniques

Toma A, Stähli B, Gebhard C et al. Keywords: myocardial infarction; stable angina; death; Chronic coronary total occlusion

ABSTRACT


AIMS - Periprocedural myocardial injury (PMI) is frequently observed after percutaneous coronary interventions (PCI) for chronic total occlusion (CTO). We investigated the prognostic impact of PMI with the antegrade or the retrograde crossing technique.


METHODS AND RESULTS - A total of 1909 patients undergoing CTO PCI were stratified according to the presence/absence of PMI (elevation of cardiac troponin T [cTnT] >5x 99th percentile of normal), and divided according to tertiles of the difference between peak and baseline cTnT within 24 hours (ΔcTnT). The primary endpoint was all-cause mortality at a median follow-up of 3.1 (interquartile range 3.0-4.4) years. PMI occurred in 19.4% and 25.4% after antegrade (n=1447) and retrograde (n=462) procedures (p<0.001). PMI was significantly associated with mortality after antegrade (adjusted HR 1.39, 95% CI 1.02-1.88, p=0.04), but not retrograde CTO PCI (adjusted HR 0.93,95% CI 0.53-1.63, p=0.80, Pint=0.02). With the antegrade, but not the retrograde approach, mortality also increased with tertiles of ΔcTnT (T1: 11.0%, T2: 18.6%, T3: 21.6%, Log Rank p<0.001).


CONCLUSIONS - Periprocedural myocardial injury was significantly associated with all-cause mortality following antegrade, but not retrograde CTO PCI. Hence, the higher risk of PMI following retrograde procedures did not translated into worse survival.

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