title: Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention.
abstract: OBJECTIVE
  We sought to evaluate the impact of crossing strategy on the incidence of periprocedural myocardial infarction (PMI) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The optimal technique for crossing coronary CTOs remains controversial.
  
  
  METHODS
  We retrospectively examined the incidence of PMI among 184 consecutive patients who underwent CTO PCI at our institution between 2012 and 2015. Creatine kinase-myocardial band fraction (CK-MB) and troponin were measured before and after PCI in all patients. PMI was defined as CK-MB increase ≥3× upper limit of normal (ULN).
  
  
  RESULTS
  Mean age was 65 ± 8 years, 98% of patients were men, 57% had diabetes mellitus, 36% were current smokers, 38% had prior heart failure, 31% had prior coronary artery bypass graft surgery (CABG), and 55% had prior PCI. The retrograde approach was used in 38% of cases. As compared with antegrade wire escalation and antegrade dissection/re-entry, use of the retrograde approach was associated with higher J-CTO (Multicenter CTO Registry of Japan) scores (P < 0.0001), higher frequency of moderate or severe calcification (P = 0.0061), longer CTO length (P < 0.0001), more frequent proximal cap ambiguity (P < 0.0001), and lower technical (P = 0.0007) and procedural (P = 0.0014) success. The frequency of PMI for the antegrade-only and retrograde cases was 10% and 33%, respectively (P = 0.0001). On multivariate analysis, use of the retrograde approach and moderate/severe calcification were independently associated with higher incidence of PMI.
  
  
  CONCLUSIONS
  As compared with antegrade-only crossing techniques, the retrograde approach is used in patients with more complex anatomy but may carry higher risk for PMI. © 2016 Wiley Periodicals, Inc.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Stetler
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Muhammad Nauman J
authors.initials: MN
authors.lastname: Tarar
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Suwetha
authors.initials: S
authors.lastname: Amsavelu
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Krishna
authors.initials: K
authors.lastname: Patel
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Erica
authors.initials: E
authors.lastname: Resendes
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Shuaib
authors.initials: S
authors.lastname: Abdullah
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015897:Comorbidity; D054059:Coronary Occlusion / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form
keywords: chronic total occlusion; percutaneous coronary intervention; periprocedural myocardial infarction