Periprocedural myocardial injury in chronic total occlusion percutaneous interventions: A systematic cardiac biomarker evaluation study

Nathan Lo, Tesfaldet T. Michael, Danyaal Moin, Vishal G. Patel, Mohammed Alomar, Aristotelis Papayannis, Daisha Cipher, Shuaib M. Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). Background The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies. Methods We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥3× the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated. Results Mean age was 64 ± 8 years. The retrograde approach was used in 26.8% of all procedures. The technical and procedural success was 77.8% and 76.6%, respectively. PMI occurred in 28 patients (8.6%, 95% confidence intervals: 5.8% to 12.2%), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8% vs. 6.7%, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013). Conclusions Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6% of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.

Original languageEnglish (US)
Pages (from-to)47-54
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume7
Issue number1
DOIs
StatePublished - Jan 2014

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Biomarkers
Percutaneous Coronary Intervention
Wounds and Injuries
MB Form Creatine Kinase
Incidence
Troponin
Ischemia
Confidence Intervals

Keywords

  • acute myocardial infarction
  • chronic total occlusion
  • complications
  • percutaneous coronary intervention
  • periprocedural myocardial injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Periprocedural myocardial injury in chronic total occlusion percutaneous interventions : A systematic cardiac biomarker evaluation study. / Lo, Nathan; Michael, Tesfaldet T.; Moin, Danyaal; Patel, Vishal G.; Alomar, Mohammed; Papayannis, Aristotelis; Cipher, Daisha; Abdullah, Shuaib M.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 1, 01.2014, p. 47-54.

Research output: Contribution to journalArticle

Lo, Nathan ; Michael, Tesfaldet T. ; Moin, Danyaal ; Patel, Vishal G. ; Alomar, Mohammed ; Papayannis, Aristotelis ; Cipher, Daisha ; Abdullah, Shuaib M. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Periprocedural myocardial injury in chronic total occlusion percutaneous interventions : A systematic cardiac biomarker evaluation study. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 1. pp. 47-54.
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abstract = "Objectives This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). Background The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies. Methods We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥3× the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated. Results Mean age was 64 ± 8 years. The retrograde approach was used in 26.8{\%} of all procedures. The technical and procedural success was 77.8{\%} and 76.6{\%}, respectively. PMI occurred in 28 patients (8.6{\%}, 95{\%} confidence intervals: 5.8{\%} to 12.2{\%}), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8{\%} vs. 6.7{\%}, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013). Conclusions Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6{\%} of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.",
keywords = "acute myocardial infarction, chronic total occlusion, complications, percutaneous coronary intervention, periprocedural myocardial injury",
author = "Nathan Lo and Michael, {Tesfaldet T.} and Danyaal Moin and Patel, {Vishal G.} and Mohammed Alomar and Aristotelis Papayannis and Daisha Cipher and Abdullah, {Shuaib M.} and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - Periprocedural myocardial injury in chronic total occlusion percutaneous interventions

T2 - A systematic cardiac biomarker evaluation study

AU - Lo, Nathan

AU - Michael, Tesfaldet T.

AU - Moin, Danyaal

AU - Patel, Vishal G.

AU - Alomar, Mohammed

AU - Papayannis, Aristotelis

AU - Cipher, Daisha

AU - Abdullah, Shuaib M.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2014/1

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N2 - Objectives This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). Background The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies. Methods We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥3× the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated. Results Mean age was 64 ± 8 years. The retrograde approach was used in 26.8% of all procedures. The technical and procedural success was 77.8% and 76.6%, respectively. PMI occurred in 28 patients (8.6%, 95% confidence intervals: 5.8% to 12.2%), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8% vs. 6.7%, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013). Conclusions Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6% of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.

AB - Objectives This study sought to evaluate the incidence, correlates, and clinical implications of periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). Background The risk of PMI during CTO PCI may be underestimated because systematic cardiac biomarker measurement was not performed in published studies. Methods We retrospectively examined PMI among 325 consecutive CTO PCI performed at our institution between 2005 and 2012. Creatine kinase-myocardial band fraction and troponin were measured before PCI and 8 to 12 h and 18 to 24 h after PCI in all patients. PMI was defined as creatine kinase-myocardial band increase ≥3× the upper limit of normal. Major adverse cardiac events during mid-term follow-up were evaluated. Results Mean age was 64 ± 8 years. The retrograde approach was used in 26.8% of all procedures. The technical and procedural success was 77.8% and 76.6%, respectively. PMI occurred in 28 patients (8.6%, 95% confidence intervals: 5.8% to 12.2%), with symptomatic ischemia in 7 of those patients. The incidence of PMI was higher in patients treated with the retrograde than the antegrade approach (13.8% vs. 6.7%, p = 0.04). During a median follow-up of 2.3 years, compared with patients without PMI, those with PMI had a higher incidence of major adverse cardiac events (hazard ratio [HR]: 2.25, p = 0.006). Patients with only asymptomatic PMI also had a higher incidence of major adverse cardiac events on follow-up (HR: 2.26, p = 0.013). Conclusions Systematic measurement of cardiac biomarkers post-CTO PCI demonstrates that PMI occurs in 8.6% of patients, is more common with the retrograde approach, and is associated with worse subsequent clinical outcomes during mid-term follow-up.

KW - acute myocardial infarction

KW - chronic total occlusion

KW - complications

KW - percutaneous coronary intervention

KW - periprocedural myocardial injury

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