Prognostic value of the high-sensitivity troponin T assay after percutaneous intervention of chronic total occlusions.

AIMS: The prognostic value of postprocedural high-sensitivity troponin T (hs-TnT) after percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is currently unclear. We aimed to assess the prognostic value of elevated hs-TnT after elective CTO-PCI. METHODS: The current study included 409 patients undergoing elective CTO-PCI between September 2011 and August 2016 at two centres who had postprocedural hs-TnT measurements available. Clinical, angiographic and procedural characteristics were correlated with any or at least five times the 99th percentile hs-TnT elevation, as well as a 1-year combined endpoint of major adverse cardiac and cerebrovascular events (MACCE) and mortality. RESULTS: Post-CTO-PCI hs-TnT elevation was observed in 85% (n = 349/409) and at least five times hs-TnT elevation occurred in 42% (n = 172/409) of cases. hs-TnT elevation was more frequent in more complex patients (postcoronary artery bypass grafting, peripheral vascular disease, chronic kidney disease, heart failure and multivessel disease) as well as in the more complex CTO procedures (higher Japanese CTO complexity, use of retrograde and antegrade dissection re-entry techniques). After 1 year of follow-up (FU), MACCE was not associated with postprocedural hs-TnT elevation, both any elevation (10.9 vs. 11.7%; P = 0.846) and at least five times hs-TnT elevation (15.7 vs. 11.7%; P = 0.451; hazard ratio = 1.375, confidence interval: 0.599-3.157, P = 0.453), compared with no elevation. A nonsignificant trend towards higher mortality in the at least five times hs-TnT vs. no elevation group (4.7 vs. 0%; P = 0.091) was observed. CONCLUSION: In patients undergoing CTO-PCI, postprocedural hs-TnT elevation is frequent, but is not correlated with higher MACCE and mortality rates after 1-year FU in our small study population, suggestive of the limited long-term impact of troponin elevation.

Outcomes of the amphilimus-eluting polymer-free stent for chronic total occlusion treatment: a multicentre experience.

AIMS: Late stent thrombosis and delayed vessel wall healing remain an important issue in coronary vessels treated with drug-eluting stents (DES), especially when long-vessel segments need to be covered, like in chronic total occlusions (CTO). Avoiding polymer use to avoid chronic inflammatory responses is a potential solution to reduce target vessel failure (TVF). We aimed to validate the clinical safety and efficacy at 1 year of the polymer-free Cre8 DES vs. nonpolymer-free DES for the percutaneous treatment of CTO. METHODS: Between September 2011 and August 2016, patients were prospectively enrolled in three CTO centres. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including cardiac death, any myocardial infarction, stent thrombosis, TVF and target vessel revascularization. RESULTS: A total of 102 Cre8 and 133 non-Cre8 patients were enrolled. At 1 year, a low cumulative MACCE was observed in the Cre8 group (6.9%, respectively). Moreover, a numerical trend towards better MACCE was observed in the Cre8 group vs. the non-Cre8 group (6.9 vs. 14.3%; P = 0.065). The clinically driven TVF rate was not statistically different between Cre8 and non-Cre8 patients (6.9 vs. 9.8%; P = 0.373). A borderline significant difference regarding mortality was observed in favour of Cre8 patients (0 vs. 3.8%; P = 0.049). CONCLUSION: Low rates of MACCE and TVF up to 1 year were observed in the Cre8 group, supportive of the use of polymer-free DES for lesions with high complexity.