Cardiac Troponin-T kinetics in retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI)

Mohamed Ayoub (Bad Oeynhausen)1, H. Omran (Bad Oeynhausen)1, M. Behnes (Mannheim)2, T. Schupp (Mannheim)2, R. Brinkmann (Bad Oeynhausen)1, T. K. Rudolph (Bad Oeynhausen)1, V. Rudolph (Bad Oeynhausen)1, K. A. Mashayekhi (Lahr/Schwarzwald)3

1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 3MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland




The retrograde approach is commonly used in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI), especially in cases with higher complexity. Nevertheless, there is limited data on cardiac biomarker kinetics after retrograde CTO PCI. We sought to assess the kinetics of cardiac troponin T (cTn-T) and major adverse cardiovascular events (MACE) after retrograde CTO PCI compared to the antegrade approach.



Methods and Results


We performed a retrospective analysis of 1,009 patients undergoing CTO PCI between 2015 and 2020. cTn-T levels were obtained at baseline and then at 8, 16, and 24 hours after CTO PCI. The mean age was 65.9±10 years, and 86% of the patients were men, 29.7% of patients had diabetes, and 21.3% of them had prior coronary artery bypass graft surgery (CABG). A total of 420 patients were treated using the retrograde approach (41.6%). Retrograde CTO procedures were significantly more complex (mean J-CTO score: 3.2±1.0 vs. 2.0±1.2, p<0.001) and associated with a higher rate of prior CABG (27.4% vs. 16.8%, p<0.001).

Median peak cTn-T after PCI was 11.2 x upper reference limit (URL), interquartile range (IQR) (3.9-28.0 x URL) and didn’t differ between antegrade and retrograde cases (11.3x URL vs. 11.1x URL, p=0.98). Repeated ANOVA measures revealed no significant differences in the cTn T kinetics between both approaches (p=0.38). Stratification according to the J-CTO score showed similar results (p for interaction 0.6).  MACE, including death, myocardial infarction, repeat revascularization, stroke, or bleeding, occurred in 15.7% over a median follow-up of 1.1 years and did not differ between antegrade and retrograde approach (Log-Rank p=0.61). 








The retrograde approach did not lead to overall higher levels of cTn-T values or to an increased MACE rate at mid-term follow-up. Modern retrograde CTO PCI is a safe and valuable approach, even for more complex lesions.

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