Impact of periprocedural myocardial injury on long-term outcomes after percutaneous coronary intervention requiring atherectomy

The prognostic implications of cardiac troponin elevation following percutaneous coronary intervention (PCI) with atherectomy have not been established. The aim of this study was to investigate the incidence of periprocedural myocardial injury (PMI) and its association with cardiovascular events in patients with severely calcified lesions undergoing PCI with atherectomy. The study analyzed 346 patients (377 lesions) who underwent PCI with atherectomy between January 2018 and December 2021. Peak post-PCI high-sensitivity cardiac troponin (hs-cTn) was measured. The primary outcome was target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization. A lesion-based analysis was conducted to assess the association of PMI with TLF up to 5 years after PCI. Elevation of hs-cTn was seen with 362 (96%) lesions, and significant PMI, defined as hs-cTn elevation ≥ 70 × upper reference limit, was seen with 83 (22%) lesions. Significant PMI was associated with a significantly higher risk of TLF (adjusted hazard ratio [aHR], 1.93; 95% confidence interval [CI], 1.12–3.30; P = 0.017), primarily driven by an elevated risk of cardiovascular death (aHR, 5.29; 95% CI, 1.46–19.16; P = 0.011). In conclusion, hs-cTn elevation was frequently observed in patients undergoing PCI with atherectomy, and significant PMI was associated with an elevated risk of TLF and cardiovascular death.