Multivessel disease and retrograde approach tied to PCI-related myocardial injury in chronic total occlusion

A recent study found that the presence of procedural complications, having multivessel artery disease, using a retrograde approach increases the incidence of Periprocedural myocardial injury in chronic total occlusion undergoing percutaneous coronary intervention. The study was published in the journal BMC Cardiovascular Diseases. 

Major adverse cardiovascular events (MACE) are linked to periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI). As there is not much data on the incidence predictors and prognosis of PMI in chronic total occlusion (CTO) undergoing PCI, researchers have conducted a prospective study to evaluate the same. 

132 individuals were enrolled and 8 of the totals with procedural failure were excluded from the study. Finally, a total of 124 CTO patients who successfully received PCI were included in the study. According to the cardiac troponin, I levels measured after the procedure, participants were divided into the PMI group having 42 patients, and the non-PMI group having 82 patients. A comparison of the baseline and angiographic characteristics of the two groups were done. The predictors of PMI and the correlation between PMI and MACE were investigated. 

Results: 

• PMI occurred in 42 patients in total (33.9%).
• PMI group had more diabetes (54.8% vs. 31.7%, P = 0.013) and dyslipidemia (54.8% vs. 13.4%, P＜0.001) when compared with the control group.
• Significant differences were found between the two groups in left ventricular ejection fraction, prior myocardial infarction, prior PCI, and prior CABG.
• More calcified lesions were found in patients with PMI and were more likely to have the multivessel disease.
• Patients in the PMI group had higher J-CTO scores and were more likely to have wire-crossing difficulties, require more use of retrograde approach, and have more procedural complications.
• Multivessel artery disease, retrograde approach, and the presence of procedural complications were predictors of PMI as seen in the multivariate analysis. 

This study shows a 33.9% incidence of PMI in CTO patients after PCI and also the predictors of PMI after CTO-PCI. Patients who develop PMI tend to have a poorer clinical prognosis and more MACE than those who do not develop PMI. 

Further reading: Kong, T., Dai, X., Luan, B. et al. Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion. BMC Cardiovasc Disord 22, 454 (2022). https://doi.org/10.1186/s12872-022-02887-0