Periprocedural myocardial injury after recanalization of chronically occluded right coronary arteries, relation to side-branch occlusion and procedural technique.
Kenji Yaginuma, Thanu Subramoniam, Gerald S Werner
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引用次数: 0
Abstract
Background: Recanalization of chronic total coronary occlusions (CTO) is associated with a high incidence of periprocedural myocardial ischemia (PMI).
Aims: This study should assess its causes with special focus on the relation to side branch occlusions (SBO) of the right coronary artery (RCA) with its specific anatomy of side branches.
Methods: 1574 recanalizations of a RCA CTO were analyzed with high-sensitive troponin T (hsTnT) drawn before and after the procedure. All angiograms were checked for SBO after the procedure. PMI was defined as hsTnT increase >5× upper limit of normal. Additional thresholds were > 18× (PMI18) and > 35× (PMI35).
Results: PMI occurred in 51.6 %, PMI18 in 19.9 %, and PMI35 in 8.9 %. Excluding procedures with major complications (3.1 %), the major determinants of PMI were chronic kidney disease, a long fluoroscopy time, and single and multiple SBO. Overall side branch occlusions occurred in 26.8 % even without PMI, and with increasing rate with higher PMI thresholds up to 56.4 % with PMI35. Proximal SBO caused the highest hsTnT increase, followed by mid and distal location. The highest incidence occurred with retrograde approach (50.8 %) and antegrade dissection re-entry (71.4 %). The combination of PMI and SBO would lead to the diagnosis of type IVa myocardial infarction in 23.4 %, with PMI18 in 10.2 %, and with PMI35 in 4.7 %.
Conclusions: SBO occur frequently after CTO PCI of the RCA and are a major determinant of PMI. Even without clinical complications the combination of various thresholds of PMI and SBO would yield a high incidence of type IVa myocardial infarction.
期刊介绍：
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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