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Baseline Features of the VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) Trial Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction Rationale and design of the GUIDE-IT study: Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography From Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events Association of Abnormal Left Ventricular Functional Reserve With Outcome in Heart Failure With Preserved Ejection Fraction The year in cardiology: heart failure: The year in cardiology 2019 Percutaneous Atriotomy for Levoatrial–to–Coronary Sinus Shunting in Symptomatic Heart Failure: First-in-Human Experience Minimizing Permanent Pacemaker Following Repositionable Self-Expanding Transcatheter Aortic Valve Replacement
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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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