Periprocedural myocardial injury after recanalization of chronically occluded right coronary arteries, relation to side-branch occlusion and procedural technique
Year: 2025
Type: article
Study design: Observational Study
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× (PMI 18 ) and > 35× (PMI 35 ). Results PMI occurred in 51.6 %, PMI 18 in 19.9 %, and PMI 35 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 PMI 35 . 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 PMI 18 in 10.2 %, and with PMI 35 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.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,490
OpenAlex ID: W4410264149