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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Periprocedural myocardial injury prognostic value after successfully treated chronic total occlusion
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Luís Graça Santos
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Luís Graça Santos; Joana Delgado Silva; Marco Costa; Luis Paiva; Hilário Oliveira; Francisco Soares; Elisabete Jorge; Cristina Neves; Lino Gonçalves
Abstract
<p><strong>Introduction:</strong> Periprocedural myocardial injury (PMI) has been generally associated with major adverse cardiac events. Limited studies addressed the clinical implication of PMI following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and all defined PMI according to creatine kinase myocardial band values.</p> <p><strong>Purpose:</strong> To evaluate the prognostic implication of PMI in patients undergoing CTO-PCI using two different troponin I (Tn-I) based definitions.</p> <p><strong>Methods:</strong> We retrospectively examined 125 consecutive CTO patients who underwent PCI attempt between December 2013 and December 2017 in our Centre. Angiographic success was achieved in 115 patients (92,0%) and measurement of Tn-I values was obtained 12-24 hours after stent implantation. Two different analysis were performed using 2 different Tn-I cutoffs to define PMI: A – Tn-I > 5 times the 99<sup>th</sup> percentile upper reference limit (URL), according to the 3<sup>rd</sup> Universal Definition of Myocardial Infarction; B – Tn-I > 35 times the URL (Academic Research Consortium-2). Baseline demographic, clinical, angiographic and procedural characteristics were compared between groups according to each PMI definition. Multivariate analysis was performed to determine the correlates of PMI and major adverse cardiovascular events (MACE) at 1-year follow up, defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI) and target lesion revascularization (TLR).</p> <p><strong>Results:</strong> Overall, mean age was 67±17 years, 25 (21.7%) patients were female, and 26 (22.6%) CTO were diagnosed following an acute coronary syndrome. PMI occurred in 41 patients (35.7%) according to definition A and in 8 patients (7.0%) using definition B. Regardless of the definition, PMI was more frequent among patients undergoing retrograde technique (RT) which was used in only 7.0% (n=8) of the procedures. Both PMI definitions were associated with higher rates of 1-year MACE and non-fatal MI (Figure 1) but failed to predict 1-year MACE. Coronary perforation and RT were associated with worse outcome while significant collateralization (RENTROP 3) showed a protective role (Figure 2).</p> <p><strong>Conclusion:</strong> In this study, low rates of PMI following CTO-PCI were observed and it was not associated with worse outcome, regardless of the definition used. Coronary perforation, RT and collaterals RENTROP 3 showed prognostic significance. More research is needed regarding troponin based PMI definition and prognostic relevance in this scenario.</p>
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