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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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Determinants of periprocedural myocardial injury after successfully treated chronic total occlusion
Session:
CO3 - Doença Coronária
Speaker:
Luís Graça Santos
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.4 Coronary Artery Disease – Treatment
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 worse prognosis regardless of the different definitions used. Limited studies have adressed the rates and risk factors of PMI in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI):</p> <p><strong>Purpose:</strong> This study sought to evaluate the frequency and determinants of PMI in successful CTO-PCI.</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 troponin I (Tn-I) values was obtained 12-24 hours after stent implantation. PMI was defined, according to the 3<sup>rd</sup> Universal Definition of Myocardial Infarction (MI), as an asymptomatic elevation of Tn-I > 5 times the 99<sup>th</sup> percentile upper reference limit (URL). Baseline demographic, clinical, angiographic and procedural characteristics were compared between groups. Multivariate analysis was performed to determine the independent risk factors of PMI.</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 event. Retrograde technique (RT) was used in only 7.0% (n=8) of the procedures. PMI occurred in 41 patients (35.7%) and was more frequent among patients with lower glomerular filtration rate and more severe CTO calcification; in longer procedures; in cases of RT use, greater total stent length or complicated with vessel dissection or mural hematoma. PMI patients also showed higher rates of 1-year major adverse cardiovascular events (a composite of cardiovascular death, non-fatal MI and target lesion revascularization), (Figure 1). Multivessel disease (odds ratio [OR]: 21.7; 95% confidence interval [CI]: 1.9-247.3; p=0.013) and procedure complication with vessel dissection or mural hematoma (OR: 5.1; 95%CI: 1.0-25.2; p=0.046) were identified as independent predictors of PMI. A risk model encompassing these variables showed good discrimination and calibration (Figure 2).</p> <p><strong>Conclusion:</strong> In this cohort, asymptomatic PMI following successful CTO-PCI occurred in about one third of the patients and was predicted by the presence of angiographic multivessel disease and iatrogenic vessel dissection or mural hematoma. These patients had worse ischemic outcomes. More research is needed to evaluate the clinical implications of CTO-PCI related PMI.</p>
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