Author + information
- Ivo M. van Dongen1,
- Joelle Elias2,
- K. Gert van Houwelingen3,
- Pierfrancesco Agostoni4,
- Bimmer EPM Claessen1,
- Loes P. Hoebers1,
- Dagmar Ouweneel5,
- Rene van der Schaaf6,
- Jan Tijssen7 and
- Jose PS Henriques1
- 1Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 2Academic Medical Centre (AMC) - University of Amsterdam, Amsterdam, Netherlands
- 3Thoraxcentrum Twente, MST Enschede, Enschede, Netherlands
- 4Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
- 5Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 6OLVG, Amsterdam, Netherlands
- 7AMC, Naarden, Netherlands
Collaterals towards a concomitant CTO are associated with improved outcome.In the EXPLORE trial, a novel observation was encountered: a decrease in collateral quality to the CTO right before CTO PCI. We have assessed the impact of this on functional and clinical outcome.
All angiograms were corelab analyzed.Well-developed (Rentrop grade 2-3) and poorly-developed (grade 0-1) collaterals were identified.LVF was measured with CMR.Long-term follow-up (median 3.9 years) was collected prospectively.
Before CTO PCI, a decay in collateral quality compared to primary PCI was observed in 34 of patients randomized to CTO PCI, and in 4 patients an increase was seen.CMR outcomes are shown in table 1.KM curves of MACE and all-cause death are shown in figure 1.
|LVEF B (%)||LVEF 4M (%)||p-value||LVEDV B (ml)||LVEDV 4M (ml)||p-value|
|Collateral quality decay||41.1 [29.8-47.3]||45.5 [35.3-55.0]||0.022*||232.4 [189-265]||208 [171-252]||0.845*|
|Collateral quality improvement||21.4 [7.6-21.4]||36.2 [27.9-47.8]||0.180ˆ||312.1[305-312]||271.8 [193-359]||0.180ˆ|
|No collateral quality change||43.4 [32.6-51.1]||45.1 [37.6-52.3]||0.006#||190 [166-247]||205 [169-245]||0.063#|
*n=18, ˆn=2, #n=67
An unique notion was made in the EXPLORE trial: 23.1% of patients with well-developed collaterals to the CTO during STEMI PCI show quality decay of the collateralization within one week.This is associated with a modest difference in cardiac function and long-term outcomes (mainly MACE) compared to patients without any change in collateral quality, which could suggest that the capability to improve quality of collaterals to a CTO during STEMI may have a protective role.However, this should be further investigated in a larger CTO population.
CORONARY: PCI Outcomes