Abstract
Background: Periprocedural myocardial infarction (PMI) has been shown to be associated with worse prognosis of patients who underwent percutaneous coronary intervention (PCI). Specific characteristics of culprit lesions detected on multidetector computed tomography (MDCT) have not been fully elucidated as predictors of PMI in patients with chronic total occlusion (CTO) lesions. We investigated to determine whether predictive MDCT characteristics exist for PMI associated with CTO PCI. Methods: 79 stable angina patients with 80 CTO lesions who underwent pre-PCI MDCT and CTO PCI at three institutions between Dec 2011 and May 2015 were included. Lesions were divided into 2 groups based on the presence (PMI group, n=20; 25%) or absence (non-PMI group, n=60; 75%) of post-PCI peak cardiac troponin (cTn) elevation of more than institutional URLx20. Clinical characteristics, procedural variables, and MDCT findings were compared between these two groups. Uni- and multivariate logistic regression analysis were performed to identify the predictors of PMI. Results: There was no significant difference in clinical characteristics between both groups. PCI success was achieved in 64 (80%) patients. Fluoroscopic time and contrast use was significantly greater in PMI group. There was no significant difference in the frequency of PMI between PCI success and failure. Frequency of the use of retrograde approach was significantly higher with PMI. In MDCT analysis, lesion length was significantly longer in PMI group (median 35.6 [IQR 26.5-45.8] mm vs. 23.7 [12.8-36.4] mm, p=0.01). Napkin-ring sign (CT density <130HU) was also significantly associated with PMI group (25.0% vs. 6.7%, p=0.04). Multivariate logistic regression analysis revealed that retrograde approach (odds ratio: 6.41; 95% confidence interval: 1.95 to 21.1; p<0.01) was a significant predictor of PMI after controlling for confounding factors. Napkin-ring sign showed a borderline significant association with PMI (odds ratio: 4.64; 95% confidence interval: 0.98 to 22.0; p=0.05). Conclusion: PMI is not uncommon in patients undergoing elective CTO PCI regardless of procedure success or failure. MDCT before PCI may help identify patients at high risk for PMI associated with CTO PCI.
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