{"id":"92d828bf8a41","type":"article","url":"https://hartvaat.nl/2018/09/01/langetermijnimpact-van-cto-rekanalisatie-bij-stemi-patienten/","title":"Langetermijnimpact van CTO-rekanalisatie bij STEMI-patiënten","title_en":"Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["obesitas","perifeer-vaatlijden","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312698","source_url":"https://doi.org/10.1136/heartjnl-2017-312698","authors":["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"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the long-term impact of concurrent CTO recanalization in STEMI patients, providing evidence on whether pursuing complete revascularization of chronic occlusions improves long-term outcomes after primary PCI.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de langetermijnuitkomsten van CTO-rekanalisatie bij patiënten met STEMI. Onderzoekt het voordeel van volledige revascularisatie inclusief CTO's.","abstract_original":"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."}