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

Abstract

EXPLORE trial number NTR1108 www.trialregister.nl.

Exercise testing after chronic total coronary occlusion revascularization in patients with STEMI and a concurrent CTO: A subanalysis of the EXPLORE‐trial

“…Previous observational studies reported a reduction in chest pain after CTO PCI compared to before CTO PCI and to failed CTO PCI . This coincides with the earlier observed higher rate of freedom of angina in the CTO PCI group at 1 year of follow‐up, compared to the no‐CTO PCI group, as reported in the long‐term outcome paper of the EXPLORE trial and the EUROCTO trial . However, the effect of CTO PCI on the occurrence of angina during stress testing was not yet examined.…”

“…Nevertheless, this regional improvement of contractility is not translated into improved global left ventricular ejection fraction (LVEF) . Furthermore, CTO PCI leads to fewer anginal complaints . Anginal complaints are typically induced by exercise, suggesting that CTO PCI could also result in improvement of exercise capacity.…”

Can coronary computed tomography angiography be the complete roadmap for chronic total occlusion management?

“…Considerable data support the use of revascularisation strategies for symptomatic relief and improvement in the quality of life of individuals with CTO,11 though the event rates seem to be comparable between medical management and revascularisation groups. While the revascularisation procedures are associated with non-negligible periprocedural complications,12 these are probably matched by the high event rate reported for the medically managed CTO population in the ICA studies. However, if such management is replicated in the lower absolute risk CTO population usually evaluated by coronary CTA, the revascularisation strategy might prove to be more harmful than the baseline reported risk.…”

Heartbeat: The ongoing controversy of intervention for chronic total coronary occlusions

“…The results of the randomised Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) study of 302 STEMI patients with successful PCI of the culprit vessel are reported in this issue of Heart. 1 Overall, there was no difference in major adverse cardiac events (MACE) at a median follow-up of 3.9 years in those with or without PCI of the CTO vessel (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; p=0.93, figure 1). Although all-cause mortality did not differ between groups, cardiac mortality was higher with CTO-PCI (6.0% vs 1.0%, p=0.02).…”