title: Periprocedural myocardial injury in chronic total occlusion percutaneous interventions: a systematic cardiac biomarker evaluation study.
abstract: OBJECTIVE
  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 x 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.
authors: Department of Internal Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Nathan
authors: N
authors: Lo
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Tesfaldet T
authors: TT
authors: Michael
authors: Department of Internal Medicine, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Danyaal
authors: D
authors: Moin
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Vishal G
authors: VG
authors: Patel
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Mohammed
authors: M
authors: Alomar
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Aristotelis
authors: A
authors: Papayannis
authors: Department of Biostatistics, University of Texas at Arlington College of Nursing, Arlington, Texas.
authors: Daisha
authors: D
authors: Cipher
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Shuaib M
authors: SM
authors: Abdullah
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Subhash
authors: S
authors: Banerjee
authors: Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
authors: Emmanouil S
authors: ES
authors: Brilakis
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form
keywords: CABG; CI; CK-MB; CTO; HR; IQR; MACE; MI; OR; PCI; PMI; ULN; acute myocardial infarction; chronic total occlusion; chronic total occlusion(s); complications; confidence interval(s); coronary artery bypass graft; creatine kinase-myocardial band; hazard ratio(s); interquartile range; major adverse cardiac events; myocardial infarction(s); odds ratio(s); percutaneous coronary intervention; percutaneous coronary intervention(s); periprocedural myocardial injury; upper limit of normal