Details

Autor(en) / Beteiligte

• Elias, Joëlle
• van Dongen, Ivo M
• Råmunddal, Truls
• Laanmets, Peep
• Eriksen, Erlend
• Meuwissen, Martijn
• Michels, H Rolf
• Bax, Matthijs
• Ioanes, Dan
• Suttorp, Maarten Jan
• Strauss, Bradley H
• Barbato, Emanuele
• Marques, Koen M
• Claessen, Bimmer E P M
• Hirsch, Alexander
• van der Schaaf, René J
• Tijssen, Jan G P
• Henriques, José P S
• Hoebers, Loes P

Titel

Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction

Ist Teil von

• Heart (British Cardiac Society), 2018-09, Vol.104 (17), p.1432-1438

Ort / Verlag

England: BMJ Publishing Group LTD

Erscheinungsjahr

2018

Quelle

MEDLINE

Beschreibungen/Notizen

• BackgroundDuring 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.MethodsThe 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.ResultsThe 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).ConclusionsIn 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 registrationEXPLORE trial number NTR1108 www.trialregister.nl.