RT Journal Article
SR Electronic
T1 Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1432
OP 1438
DO 10.1136/heartjnl-2017-312698
VO 104
IS 17
A1 Joëlle Elias
A1 Ivo M van Dongen
A1 Truls Råmunddal
A1 Peep Laanmets
A1 Erlend Eriksen
A1 Martijn Meuwissen
A1 H Rolf Michels
A1 Matthijs Bax
A1 Dan Ioanes
A1 Maarten Jan Suttorp
A1 Bradley H Strauss
A1 Emanuele Barbato
A1 Koen M Marques
A1 Bimmer E P M Claessen
A1 Alexander Hirsch
A1 René J van der Schaaf
A1 Jan G P Tijssen
A1 José P S Henriques
A1 Loes P Hoebers
A1 ,
YR 2018
UL http://heart.bmj.com/content/104/17/1432.abstract
AB 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.