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

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

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Abstract

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.
Original languageEnglish
Pages (from-to)1432-1438
JournalHeart
Volume104
Issue number17
DOIs
Publication statusPublished - 2018

Cite this

Elias, J., van Dongen, I. M., Råmunddal, T., Laanmets, P., Eriksen, E., Meuwissen, M., ... Hoebers, L. P. (2018). Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction. Heart, 104(17), 1432-1438. https://doi.org/10.1136/heartjnl-2017-312698