Association of periprocedural myocardial infarction with long-term survival in patients treated with coronary revascularization therapy of chronic total occlusion.

Abstract

To evaluate the impact of periprocedural myocardial infarction (PMI) on long-term survival after coronary revascularization in patients with chronic total occlusion (CTO). Little is known about the clinical impact of PMI on long-term cardiac mortality after CTO revascularization in patients with stable angina. We analyzed data from 927 patients with CTO and stable angina who were treated with coronary artery bypass grafting (CABG, n = 367) or percutaneous coronary intervention (PCI, n = 560). PMI was defined as a peak CK-MB ≥ 3 times the upper limit of normal (ULN) after PCI or a CK-MB ≥ 5 times the ULN after CABG. The primary outcome was cardiac death in patients with PMI (PMI group, n = 118 [12.7%]) or without PMI (no-PMI group, n = 809 [87.3%]) after revascularization. During a median follow-up of 42 months, PMI occurred in 118 patients (12.7% of the overall study population). Fifty-nine patients treated with PCI (10.5% of PCI subgroup) and 59 patients treated with CABG (16.1% of CABG subgroup) suffered from PMI. In multivariate analysis, the PMI group and the no-PMI group had a similar incidence of cardiac death (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.20 to 1.62; P = 0.29). PMI may not be associated with increased cardiac mortality after coronary revascularization in patients with stable CTO. © 2015 Wiley Periodicals, Inc.