| Objective: To evaluate the predictors and prognostic impact of PMI following PCI in patients with CTO.Methods: This study retrospectively included 247 patients diagnosed with CTO by coronary angiography in our hospital from December 2020 to December 2022,excluding 11 patients who failed procedure,and 236 patients(95.5%)had successful procedure.Serum troponin(c Tn-I)values were measured within 12-24 hours after surgery,and they were divided into PMI group(n=72)and no PMI group(n=164)according to c Tn-I levels.Baseline data,laboratory test results,and PCI procedural data were collected from both groups.SPSS26.0 statistical software was used to analyze and compare the differences in patient data between the two groups,and the variables with statistical differences in descriptive statistics were included in univariate logistic regression analysis,and the variables with p<0.05 in univariate regression analysis were included in multivariate logistic regression analysis to analyze the independent predictors of PMI.At the same time,the occurrence of major adverse cardiovascular events(MACE)during the hospital and within 6 months after discharge from the two groups was followed.Result: 1.PMI developed in 72(30.5%)of the patients included in the study.2.Compared with patients without PMI,patients in the PMI group had higher body mass index(25.5±3.3 vs 24.5±2.8),more hypertension(65.3% vs 46.3%,P=0.007),diabetes mellitus(52.8% vs.37.2%,P=0.026)and dyslipidemia(48.6% vs 39.6%,P=0.199),and lower left ventricular ejection fraction(43.7±7.4 vs 46.8±8.3,P= 0.008),with pre-existing old myocardial infarction(62.5% vs 29.3%,P<0.001),prior PCI(58.3% vs 15.9%,P< 0.001),and prior CABG(coronary artery bypass graft(CABG)(8.3% vs 1.2%,P=0.005).In terms of contrast results,patients in the PMI group had more multivessel disease(70.8% vs 38.4%,P<0.001),more calcified lesions(55.6% vs 23.2%,P<0.001),and higher J-CTO scores(2.2±0.8 vs 1.5±0.9,P<0.001).In terms of surgical characteristics,patients in the PMI group had more difficulty in passing guidewires through lesions(56.9% vs 40.9%,P=0.022),used more retrograde approach(47.2% vs 8.5%,P<0.001),had longer procedural time(91.1±25.4 vs 69.4±25.4,P=0.005),used more contrast medium(195.4±94.7 vs 166.1±57.9,P=0.004),and had procedural complications(1.1% vs 1.2%,P=0.001)more.3.In univariate regression analysis,hypertension(OR,2.117;CI,1.226-3.865;P=0.008),diabetes mellitus(OR,1.887;CI,1.077-3.306;P=0.026),old myocardial infarction(OR,4.028;CI,2.247-7.221;P<0.001),prior PCI therapy(OR,7.431;CI,3.963-13.932;P<0.001),multivessel disease(OR,3.893;CI,2.142-7.078;P<0.001),calcified lesions(OR,4.145;CI,2.298-7.474;P<0.001),and retrograde approach(OR,9.586;CI,4.680-19.636;P<0.001)are more likely to have PMI.In multivariate regression analysis,prior PCI treatment(OR,9.586;CI,1.198-19.310;P=0.002),multivessel disease(OR,2.519;CI,1.221-5.198;P=0.012),retrograde approach(OR,6.512;CI,2.732-15.523;P<0.001),and intraoperative complications(OR,8.747;CI,1.450-52.758;P= 0.018)is a predictor of PMI.In multivariate regression analysis,prior PCI treatment(OR,5.763;CI,1.198-19.310;P=0.002),multivessel disease(OR,2.519;CI,1.221-5.198;P=0.012),retrograde approach(OR,6.512;CI,2.732-15.523;P<0.001)and the presence of procedural complications(OR,8.747;CI,1.450-52.758;P=0.018)were predictors of PMI.4.In addition,patients with PMI were more likely to develop MACE than patients without PMI(13.9% vs 2.4%,P=0.001).Conclusion:1.In this study,the incidence of PMI after PCI is about 30%.2.Previous PCI treatment,presence of multivessel disease,retrograde approach,and procedural complications are predictors of PMI after CTO-PCI.3.Patients who develop PMI are more likely to develop MACE than control group.Adverse prognosis can be avoided by assessing the patient’s baseline data and surgical performance to conduct health testing and risk assessment of patients treated with CTO-PCI. |
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