Author + information
- Joelle Elias1,
- Ivo van Dongen2,
- Loes Hoebers3,
- Dagmar Ouweneel4,
- Bimmer Claessen5 and
- Jose Henriques6
- 1Academic Medical Centre (AMC) - University of Amsterdam, Amsterdam, Netherlands
- 2AMC, Amsterdam, Netherlands
- 3Academic Medical Center, Amsterdam, Netherlands
- 4Academic Medical Center, Amsterdam, Netherlands
- 5Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
The optimal treatment for the CTO found during primary PCI in STEMI patients remains unknown and the best strategy may be based on coronary location of the CTO.
In this EXPLORE substudy, we evaluated LVEF and LVEDV measured on 4 months cardiac MRI, compared across the different coronary locations of the CTO, in STEMI patients with a concurrent CTO, comparing CTO-PCI versus no CTO-PCI. Procedural success rates of CTO PCI were calculated for each CTO.
Of the 302 STEMI patients with a CTO who were randomized between CTO PCI and no CTO PCI, the CTO was located in LAD: 75 (25%), RCA: 142 (47%) and LCX: 85 (28%). CTO PCI success percentages were; LAD: 80.1%, RCA: 65.1% and LCX: 79.2% (p=0.14). Functional MRI data at 4 months was available for 259 patients. In these patients CTO PCI compared with no CTO PCI resulted in a higher LVEF and lower LVEDV at in LAD but not in RCA and LCX (figure 1). However, in a subgroup of patients with paired MRIs (n=181) CTO PCI did not result in a significant change in LVEF (Δ; LAD: 3.9% vs 3.8%, p=0.97; RCA: 5.9% vs 3.5%, p=0.21; LCX: 3.3% vs 4.5%, p=0.59) or change in LVEDV (Δ; LAD: 6.3ml vs -4.0ml, p=0.19; RCA: -1.7ml vs 6.9ml, p=0.20; LCX: 15.0ml vs 0.8ml, p=0.08).
Success percentage of CTO PCI is different between the CTO coronary locations. Furthermore the coronary location of the CTO is of influence on the effect of CTO PCI. At 4 months follow-up CTO PCI of the LAD, but not the RCA or LCX, results in a higher LVEF and lower LVEDV compared to no CTO PCI. In a subgroup analysis of paired MRI data however this effect could not be confirmed.
CORONARY: PCI Outcomes