TY - JOUR T1 - Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction JF - Heart JO - Heart SP - 1432 LP - 1438 DO - 10.1136/heartjnl-2017-312698 VL - 104 IS - 17 AU - Joëlle Elias AU - Ivo M van Dongen AU - Truls Råmunddal AU - Peep Laanmets AU - Erlend Eriksen AU - Martijn Meuwissen AU - H Rolf Michels AU - Matthijs Bax AU - Dan Ioanes AU - Maarten Jan Suttorp AU - Bradley H Strauss AU - Emanuele Barbato AU - Koen M Marques AU - Bimmer E P M Claessen AU - Alexander Hirsch AU - René J van der Schaaf AU - Jan G P Tijssen AU - José P S Henriques AU - Loes P Hoebers A2 - , Y1 - 2018/09/01 UR - http://heart.bmj.com/content/104/17/1432.abstract N2 - Background During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.Methods The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.Results The median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).Conclusions In this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.Clinical trial registration EXPLORE trial number NTR1108 www.trialregister.nl. ER -