Author + information
- Received May 9, 2016
- Revision received July 5, 2016
- Accepted July 13, 2016
- Published online October 11, 2016.
- S0735109716347957-046131db600e6641a68826778824323cJosé P.S. Henriques, MD, PhDa,∗ (, )
- S0735109716347957-2620876984f50438a99d37c2810b43c9Loes P. Hoebers, MDa,
- S0735109716347957-26b3de849a3d21ed8ed3b21fd1ee8895Truls Råmunddal, MD, PhDb,
- S0735109716347957-96058e993af1fb6fcd8a0b2191f24f55Peep Laanmets, MDc,
- S0735109716347957-7626b0e276be4e1fcb0cd5da28bfe487Erlend Eriksen, MDd,
- S0735109716347957-6ca8b19cb9aac07e0cb4a4f9ea759e4aMatthijs Bax, MDe,
- S0735109716347957-49ff9e2fa6bfa24e1c062cd7c1b98cf2Dan Ioanes, MDb,
- S0735109716347957-9de9f2234db80efc332d8496ca2a6095Maarten J. Suttorp, MD, PhDf,
- S0735109716347957-3683484da025a5cacfd43f0ef23cd0e6Bradley H. Strauss, MD, PhDg,
- S0735109716347957-42e5e43cb191f467dbe8227c5e8a4eacEmanuele Barbato, MD, PhDh,
- S0735109716347957-b46350bb440e4ca676b3c875834704cfRobin Nijveldt, MD, PhDi,
- S0735109716347957-cc6999c9101d6d73a0595881136ede7aAlbert C. van Rossum, MD, PhDi,
- S0735109716347957-d6e0ff73f257bc3bbebf01118dc7c915Koen M. Marques, MD, PhDi,
- S0735109716347957-b73540e99423a4502e25d42f1b6bdc1eJoëlle Elias, MDa,
- S0735109716347957-5507da6e0298cfed0443d0b0d1082f0fIvo M. van Dongen, MDa,
- S0735109716347957-33745fe1b80469e9dec48c0c21c20c67Bimmer E.P.M. Claessen, MD, PhDa,
- S0735109716347957-cf188f8aee43d935c0fc4acd4c67eaf5Jan G. Tijssen, PhDa,
- S0735109716347957-d14f00e262b49c17d60fa61e9329f2b2René J. van der Schaaf, MD, PhDj,
- EXPLORE Trial Investigators
- aAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- bSahlgrenska University Hospital, Gothenburg, Sweden
- cNorth Estonia Medical Center, Tallinn, Estonia
- dHaukeland University Hospital, Bergen, Norway
- eHaga Teaching Hospital, The Hague, the Netherlands
- fSint Antonius Ziekenhuis, Nieuwegein, the Netherlands
- gSunnybrook Health Sciences Centre, Toronto, Canada
- hOnze Lieve Vrouwe Ziekenhuis, Aalst, Belgium
- iVU University Medical Center, Amsterdam, the Netherlands
- jOnze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. José P.S. Henriques, Department of Cardiology, B2-115, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Background In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non–infarct-related artery is present and is associated with increased morbidity and mortality.
Objectives The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Elevation Myocardial Infarction) trial evaluated whether patients with STEMI and concurrent CTO in a non–infarct-related artery benefit from additional percutaneous coronary intervention (PCI) of CTO shortly after primary PCI.
Methods From November 2007 through April 2015, we enrolled 304 patients with acute STEMI who underwent primary PCI and had concurrent CTO in 14 centers in Europe and Canada. A total of 150 patients were randomly assigned to early PCI of the CTO (CTO PCI), and 154 patients were assigned to conservative treatment without PCI of the CTO (no CTO PCI). Primary outcomes were left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac magnetic resonance imaging after 4 months.
Results The investigator-reported procedural success rate in the CTO PCI arm of the trial was 77%, and the adjudicated success rate was 73%. At 4 months, mean LVEF did not differ between the 2 groups (44.1 ± 12.2% vs. 44.8 ± 11.9%, respectively; p = 0.60). Mean LVEDV at 4 months was 215.6 ± 62.5 ml in the CTO PCI arm versus 212.8 ± 60.3 ml in the no–CTO PCI arm (p = 0.70). Subgroup analysis revealed that patients with CTO located in the left anterior descending coronary artery who were randomized to the CTO PCI strategy had significantly higher LVEF compared with patients randomized to the no–CTO PCI strategy (47.2 ± 12.3% vs. 40.4 ± 11.9%; p = 0.02). There were no differences in terms of 4-month major adverse coronary events (5.4% vs. 2.6%; p = 0.25).
Conclusions Additional CTO PCI within 1 week after primary PCI for STEMI was feasible and safe. In patients with STEMI and concurrent CTO, we did not find an overall benefit for CTO PCI in terms of LVEF or LVEDV. The finding that early CTO PCI in the left anterior descending coronary artery subgroup was beneficial warrants further investigation. (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Segment Elevation Myocardial Infarction; NTR1108)
- chronic total occlusion percutaneous coronary intervention
- ST-segment elevation myocardial infarction
The study was investigator initiated with a research grant provided by Abbott Vascular International. The grantors had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This investigator-initiated study was funded by the Academic Medical Center, University of Amsterdam, in combination with a research grant from Abbott Vascular. Dr. Henriques has received grants from Abbott Vascular during the conduct of the study; and has received grants from BBraun, Abiomed, and Biotronik outside the submitted work. Dr. van der Schaaf has received grants from Abbott Vascular, Biotronik, and Biosensors; has received personal fees from Biotronik and Boston Scientific; has been a consultant for Biotronik; and has received speakers fees from OrbusNeich, Boston Scientific, and Asahi Intecc outside the submitted work. Dr. Råmunddal has been a proctor for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Henriques and Hoebers contributed equally to this work.
William Lombardi, MD, served as Guest Editor for this paper.
- Received May 9, 2016.
- Revision received July 5, 2016.
- Accepted July 13, 2016.
- American College of Cardiology Foundation