# Langetermijnimpact van CTO-rekanalisatie bij STEMI-patiënten

*geplaatst 2018-09-01 · Algemeen · Heart (British Cardiac Society) · doi 10.1136/heartjnl-2017-312698 · https://hartvaat.nl/2018/09/01/langetermijnimpact-van-cto-rekanalisatie-bij-stemi-patienten/*

Studie naar de langetermijnuitkomsten van CTO-rekanalisatie bij patiënten met STEMI. Onderzoekt het voordeel van volledige revascularisatie inclusief CTO's.

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

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Heart (British Cardiac Society), https://doi.org/10.1136/heartjnl-2017-312698. Bijgewerkt 2026-07-03T13:26:41Z. 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.