Abstract 12969: Role of Elevated High-Sensitivity Cardiac Troponin T in Determining the Clinical and Angiographic Outcomes in Patients With Chronic Total Occlusion Undergoing Percutaneous Intervention: A Meta-Analysis

Abstract

Background: Percutaneous Coronary Intervention of Chronic Total Occlusion (CTO-PCI) leads to higher periprocedural myocardial injury (PMI); however, the prognostic value of high-sensitive-Cardiac Troponin T (Hs-cTnT) in CTO-PCI outcomes is not well studied. This review evaluated the association of Hs-cTnT with major adverse cardiovascular events (MACE) following CTO-PCI. Methods: We conducted a thorough literature search in PubMed, Scopus, Embase, and Google Scholar, using relevant keywords, to identify studies up to 2022. The primary outcome of interest was MACE, which included all-cause mortality, PMI, target vessel revascularization (TVR), and target vessel re-occlusion (TVRO). Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using binary random-effects models. Heterogeneity was assessed using I 2 statistics. Results: Our analysis included four studies investigating 1499 post-CTO-PCI patients (mean age 66.77±10.09 years, 81.5% male). Patients with multivessel disease, retrograde approach, and previous PCI or coronary artery bypass graft procedures were more likely to present with elevated Hs-cTnT levels due to the complexity of the procedure. No difference in baseline comorbidities was noted in patients with and without elevated Hs-cTnT, including diabetes and hypertension. There was no significant association between Hs-cTnT levels and MACE (OR:1.56 p=0.25), TVR (OR:2.03, p=0.22), PMI (OR:3.45, p=0.07), and mortality (OR:2.35, p=0.14) ( Figure 1) . However, a significant association was found between Hs-cTnT levels and TVRO [OR:8.78 (95% C.I. 3.64-21.17) p<0.01, I2 0%]. Conclusion: Patients with elevated Hs-cTnT levels have a nine-fold higher risk of TVRO than those with normal levels in CTO-PCI. Periprocedural Hs-cTnT measurement can be utilized for risk stratification of TVRO after CTO-PCI with no association with MACE. Overall smaller sample size warrants more randomized studies to substantiate the results.