title: Periprocedural Myocardial Injury After Recanalization of Single Chronic Coronary Occlusion - A Propensity Score Analysis Comparing Long-Term Clinical Outcomes.
abstract: BACKGROUND
  Rates and importance of periprocedural myocardial injury (PMI) after crossing coronary chronic total occlusions (CTOs) is not well understood. This study sought to investigate long-term clinical implications of PMI in patients undergoing percutaneous coronary intervention (PCI) for single CTO utilizing antegrade technique.
  
  
  METHODS
  Out of 11,957 patients undergoing non-urgent PCI, a total of 1110 patients with symptomatic angina and single CTO were treated by antegrade PCI and observed for up to 10 years. The primary objective included cardiac death, while the secondary aim comprised all major adverse cardiovascular and cerebrovascular event (MACCE) rate.
  
  
  RESULTS
  Troponin-defined PMI occurred in 4.7% patients (n = 52). At 1 year, the cardiac death and MACCE rates were significantly higher in patients with vs without PMI (hazard ratio [HR], 5.72; 95% confidence interval [CI], 1.59-20.49; P=.01; HR, 1.84; 95% CI, 1.07-3.18; P=.03, respectively). At long-term follow-up, patients with PMI had a trend toward a higher incidence of cardiac death than patients without PMI (HR, 2.51; 95% CI, 0.99-6.33; P=.05) and no differences were demonstrated in terms of overall MACCE between both groups (HR, 1.19; 95% CI, 0.73-1.93; P=.49). After propensity score adjustment, no significant differences were observed regarding the short-term and long-term outcomes.
  
  
  CONCLUSIONS
  CTO-PCI is a safe procedure if routinely performed in symptomatic patients at a high-volume center. PMI does not influence long-term outcomes after antegrade CTO-PCI.
authors.affiliation: First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-210 Gdansk, Poland. mjaguszewski@escardio.com.pl.
authors.forename: Milosz
authors.initials: M
authors.lastname: Jaguszewski
authors.forename: Natasza
authors.initials: N
authors.lastname: Gilis-Malinowska
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Gutierrez-Chico
authors.forename: Michal
authors.initials: M
authors.lastname: Chmielecki
authors.forename: Pawel
authors.initials: P
authors.lastname: Skarzynski
authors.forename: Slawomir
authors.initials: S
authors.lastname: Burakowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Drewla
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Targonski
authors.forename: Lukasz
authors.initials: L
authors.lastname: Lewicki
authors.forename: Witold
authors.initials: W
authors.lastname: Dubaniewicz
authors.forename: Marcin
authors.initials: M
authors.lastname: Fijalkowski
authors.forename: Marcin
authors.initials: M
authors.lastname: Gruchala
authors.forename: Dariusz
authors.initials: D
authors.lastname: Ciecwierz
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009204:Myocardial Revascularization / Q000009:adverse effects*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011044:Poland / Q000453:epidemiology; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin