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

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