Incidence, predicting factors, and clinical outcomes of periprocedural myocardial infarction after percutaneous coronary intervention for chronic total occlusion in the era of new-generation drug-eluting stents
Jin-Ho Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorCorresponding Author
Byeong-Keuk Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Correspondence Byeong-Keuk Kim, MD, PhD, Division of Cardiology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, South Korea. Email: [email protected]Search for more papers by this authorSeunghwan Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorChul-Min Ahn MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorJung-Sun Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYoung-Guk Ko MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorDonghoon Choi MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorMyeong-Ki Hong MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYangsoo Jang MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorJin-Ho Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorCorresponding Author
Byeong-Keuk Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Correspondence Byeong-Keuk Kim, MD, PhD, Division of Cardiology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, South Korea. Email: [email protected]Search for more papers by this authorSeunghwan Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorChul-Min Ahn MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorJung-Sun Kim MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYoung-Guk Ko MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorDonghoon Choi MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorMyeong-Ki Hong MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYangsoo Jang MD
Department of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorAbstract
Objective
This study aimed to examine predictors and clinical outcomes of periprocedural myocardial infarction (PMI) after chronic total occlusion (CTO) intervention.
Background
There are limited data on the clinical implications of PMI after CTO intervention in the new-generation drug-eluting stent (DES) era.
Methods
We enrolled 337 patients who underwent CTO intervention and met the study criteria. We evaluated the incidence and predictors of PMI, defined as an increase in creatine kinase-MB ≥3× the upper limit of normal (ULN) after intervention and compared the occurrence rates of major adverse cardiac and cerebrovascular events (MACCE, defined as the composite of cardiac death, myocardial infarction, stent thrombosis, target-vessel revascularization, or cerebrovascular accidents) between the PMI and non-PMI groups.
Results
PMI occurred in 23 (6.8%) patients after CTO intervention. Significant independent predictors were previous bypass surgery [odds ratio (OR) = 5.52, 95% confidence interval (CI) = 1.17–25.92; P = 0.03], Japan-CTO score ≥3 (OR = 7.06, 95%CI = 2.57–19.39; P < 0.001), side branch occlusion (OR = 4.21, 95%CI = 1.13–15.66; P = 0.03), and longer procedure time (OR = 4.18, 95%CI = 1.35–12.99; P = 0.01). During a median follow-up of 29.6 months, the PMI group had a significantly higher MACCE rate than the non-PMI group (23.7 vs. 5.6%, P = 0.008 by log-rank test). PMI was an independent predictor of MACCE (HR = 4.26, 95%CI = 1.35–13.43; P = 0.01). The MACCE rate gradually increased in a CK-MB-dependent fashion and was highest in patients with ≥10× ULN (P = 0.005).
Conclusion
Previous bypass surgery, high Japan-CTO score, side branch occlusion, and longer procedure time were strongly related to PMI occurrence after CTO intervention. PMI was significantly associated with worse clinical outcomes in the new-generation DES era.
CONFLICTS OF INTEREST
None
Supporting Information
Additional Supporting Information may be found online in the supporting information tab for this article.
| Filename | Description |
|---|---|
| ccd27420-sup-0001-suppinfo1.docx18.4 KB |
Supporting Information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60: 1581–1598.
- 2 Lo N, Michael TT, Moin D, Patel VG, Alomar M, Papayannis A, Cipher D, Abdullah SM, Banerjee S, Brilakis ES. Periprocedural myocardial injury in chronic total occlusion percutaneous interventions. A Systematic Cardiac Biomarker Evaluation Study. JACC Cardiovasc Interv 2014; 7: 47–54.
- 3 Kim BK, Kim JS, Park J, Ko YG, Choi D, Jang Y, Hong MK. Comparison of optical coherence tomographic assessment between first- and second-generation drug-eluting stents. Yonsei Med J 2012; 53: 524–529.
- 4 Kim BK, Shin S, Shin DH, Hong MK, Gwon HC, Kim HS, Yu CW, Park HS, Chae IH, Rha SW, Lee SH, Kim MH, Hur SH, Jang Y. Clinical outcome of successful percutaneous coronary intervention for chronic total occlusion: Results from the multicenter Korean Chronic Total Occlusion (K-CTO) registry. J Invasive Cardiol 2014; 26: 255–259.
- 5 Hong SJ, Kim BK, Shin DH, Kim JS, Hong MK, Gwon HC, Kim HS, Yu CW, Park HS, Chae IH, Rha SW, Lee SH, Kim MH, Hur SH, Jang Y. Usefulness of intravascular ultrasound guidance in percutaneous coronary intervention with second-generation drug-eluting stents for chronic total occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry). Am J Cardiol 2014; 114: 534–540.
- 6 Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW. Clinical end points in coronary stent trials: A case for standardized definitions. Circulation 2007; 115: 2344–2351.
- 7 Arora RR, Raymond RE, Dimas AP, Bhadwar K, Simpfendorfer C. Side branch occlusion during coronary angioplasty: Incidence, angiographic characteristics, and outcome. Cathet Cardiovasc Diagn 1989; 18: 210–212.
- 8 Zhang Q, Hu J, Yang ZK, Ding FH, Zhang JS, Du R, Zhu TQ, Shen WF, Kirtane AJ, Zhang RY. Correlates and outcomes related to periprocedural myocardial injury during percutaneous coronary intervention for chronic total occlusion: Results from a prospective, single center PCI registry. Catheter Cardiovasc Interv 2016; 87: 616–623.
- 9 Di Serafino L, Borgia F, Maeremans J, Pyxaras SA, De Bruyne B, Wijns W, Heyndrickx GR, Dens J, Di Mario C, Barbato E. Periprocedural myocardial injury and long-term clinical outcome in patients undergoing percutaneous coronary interventions of coronary chronic total occlusion. J Invasive Cardiol 2016; 28: 410–414.
- 10 Lee PH, Lee SW, Park HS, Kang SH, Bae BJ, Chang M, Roh JH, Yoon SH, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Successful recanalization of native coronary chronic total occlusion is not associated with improved long-term survival. JACC Cardiovasc Interv 2016; 9: 530–538.
- 11 Borgia F, Viceconte N, Ali O, Stuart-Buttle C, Saraswathyamma A, Parisi R, Mirabella F, Dimopoulos K, Di Mario C. Improved cardiac survival, freedom from MACE and angina-related quality of life after successful percutaneous recanalization of coronary artery chronic total occlusions. Int J Cardiol 2012; 161: 31–38.
- 12 Jang WJ, Yang JH, Choi SH, Song YB, Hahn JY, Kim WS, Lee YT, Kim BS, Gwon HC. Association of periprocedural myocardial infarction with long-term survival in patients treated with coronary revascularization therapy of chronic total occlusion. Catheter Cardiovasc Interv 2016; 87: 1042–1049.
- 13 Lansky AJ, Stone GW. Periprocedural myocardial infarction: Prevalence, prognosis, and prevention. Circ Cardiovasc Interv 2010; 3: 602–610.
- 14 Cuculi F, Lim CC, Banning AP. Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented? Heart 2010; 96: 736–740.
- 15 Califf RM, Abdelmeguid AE, Kuntz RE, Popma JJ, Davidson CJ, Cohen EA, Kleiman NS, Mahaffey KW, Topol EJ, Pepine CJ, Lipicky RJ, Granger CB, Harrington RA, Tardiff BE, Crenshaw BS, Bauman RP, Zuckerman BD, Chaitman BR, Bittl JA, Ohman EM. Myonecrosis after revascularization procedures. J Am Coll Cardiol 1998; 31: 241–251.
- 16 Nienhuis MB, Ottervanger JP, Bilo HJ, Dikkeschei BD, Zijlstra F. Prognostic value of troponin after elective percutaneous coronary intervention: A meta-analysis. Catheter Cardiovasc Interv 2008; 71: 318–324.
- 17 Ghazzal Z, Ashfaq S, Morris DC, Douglas JS, Marshall JJ, King SB III, Weintraub WS. Prognostic implication of creatine kinase release after elective percutaneous coronary intervention in the pre-IIb/IIIa antagonist era. Am Heart J 2003; 145: 1006–1012.
- 18 Galassi AR, Sianos G, Werner GS, Escaned J, Tomasello SD, Boukhris M, Castaing M, Büttner JH, Bufe A, Kalnins A, Spratt JC, Garbo R, Hildick-Smith D, Elhadad S, Gagnor A, Lauer B, Bryniarski L, Christiansen EH, Thuesen L, Meyer-Geßner M, Goktekin O, Carlino M, Louvard Y, Lefèvre T, Lismanis A, Gelev VL, Serra A, Marzà F, Di Mario C, Reifart N. Retrograde recanalization of chronic total occlusions in Europe: Procedural, in-hospital, and long-term outcomes from the multicenter ERCTO registry. J Am Coll Cardiol 2015; 65: 2388–2400.
- 19 Galassi AR, Brilakis ES, Boukhris M, Tomasello SD, Sianos G, Karmpaliotis D, Di Mario C, Strauss BH, Rinfret S, Yamane M, Katoh O, Werner GS, Reifart N. Appropriateness of percutaneous revascularization of coronary chronic total occlusions: An overview. Eur Heart J 2016; 37: 2692–2700.
- 20 Toma A, Stahli BE, Gick M, Colmsee H, Gebhard C, Mashayekhi K, Ferenc M, Neumann FJ, Buettner HJ. Long-term follow-up of patients with previous coronary artery bypass grafting undergoing percutaneous coronary intervention for chronic total occlusion. Am J Cardiol 2016; 118: 1641–1646.
- 21 Tanaka H, Morino Y, Abe M, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Morimoto T, Hinohara T, Fujii T, Mitsudo K. Impact of J-CTO score on procedural outcome and target lesion revascularisation after percutaneous coronary intervention for chronic total occlusion: A substudy of the J-CTO Registry (Multicentre CTO Registry in Japan). EuroIntervention 2016; 11: 981–988.
- 22 Christopoulos G, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi W, Grantham JA, Yeh RW, Jaffer FA, Cipher DJ, Rangan BV, Christakopoulos GE, Kypreos MA, Lembo N, Kandzari D, Garcia S, Thompson CA, Banerjee S, Brilakis ES. Clinical utility of the Japan-chronic total occlusion score in coronary chronic total occlusion interventions: Results from a multicenter registry. Circ Cardiovasc Interv 2015; 8: e002171.
- 23 Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Hinohara T, Tanaka H, Mitsudo K. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv 2011; 4: 213–221.
- 24 Park DW, Kim YH, Yun SC, Ahn JM, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention. Eur Heart J 2013; 34: 1662–1669.
- 25 Zhang D, Xu B, Yin D, Li Y, He Y, You S, Qiao S, Wu Y, Yan H, Yang Y, Gao R, Dou K. Predictors and periprocedural myocardial injury rate of small side branches occlusion in coronary bifurcation intervention. Medicine (Baltimore) 2015; 94: e992.
- 26 Michael TT, Karmpaliotis D, Brilakis ES, Alomar M, Abdullah SM, Kirkland BL, Mishoe KL, Lembo N, Kalynych A, Carlson H, Banerjee S, Luna M, Lombardi W, Kandzari DE. Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization: Insights from a multicenter United States registry. Catheter Cardiovasc Interv 2015; 85: 393–399.
- 27 Sapontis J, Christopoulos G, Grantham JA, Wyman RM, Alaswad K, Karmpaliotis D, Lombardi WL, McCabe JM, Marso SP, Kotsia AP, Rangan BV, Christakopoulos GE, Garcia S, Thompson CA, Banerjee S, Brilakis ES. Procedural failure of chronic total occlusion percutaneous coronary intervention: Insights from a multicenter US registry. Catheter Cardiovasc Interv 2015; 85: 1115–1122.
- 28 Lee SW, Lee PH, Kang SH, Choi H, Chang M, Roh JH, Yoon SH, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Determinants and prognostic significance of periprocedural myocardial injury in patients with successful percutaneous chronic total occlusion interventions. JACC Cardiovasc Interv 2016; 9: 2220–2228.
- 29 van Houwelingen KG, Sen H, Lam MK, Tandjung K, Lowik MM, de Man FH, Louwerenburg JH, Stoel MG, Hartmann M, Linssen GC, Doggen CJ, von Birgelen C. Three-year clinical outcome after treatment of chronic total occlusions with second-generation drug-eluting stents in the TWENTE trial. Catheter Cardiovasc Interv 2015; 85: E76–E82.
- 30 Prasad A, Herrmann J. Myocardial infarction due to percutaneous coronary intervention. N Engl J Med 2011; 364: 453–464.
