SAN FRANCISCO – Recanalization of a chronic total occlusion in a noninfarct-related artery within a week after primary percutaneous coronary intervention was safe and feasible but did not improve overall left ventricular ejection fraction or LV end diastolic volume in the randomized, prospective EXPLORE trial.
At 4 months after primary percutaneous coronary intervention (pPCI), cardiac magnetic resonance imaging showed that left ventricular ejection fraction (LVEF) was similar in 136 patients who underwent chronic total occlusion percutaneous coronary intervention (CTO-PCI) and 144 who did not undergo CTO-PCI (44.1 and 44.8, respectively) within 1 week after the pPCI, Dr. Jose P.S. Henriques reported at the Transcatheter Cardiovascular Therapeutics annual meeting.
Dr. Jose P.S. Henriques
LV end diastolic volume also was similar in the two groups (215.6 and 212.8, respectively), Dr. Henriques of the Academic Medical Center, Amsterdam, said at the meeting, which was sponsored by the Cardiovascular Research Foundation.
A subgroup analysis, however, showed that LVEF did improve significantly with CTO-PCI in 69 patients whose CTOs were located in the left anterior descending (LAD) artery, compared with 211 patients with non-LAD CTOs (treatment effect, 6.8 vs. –3.2), Dr. Henriques said.
Patients enrolled in the EXPLORE trial had a mean age of 60 years, and most were men (89% in the CTO-PCI group and 82% in the non-CTO-PCI group). The two groups were well balanced with respect to clinical and demographic characteristics. Of note, both groups had a high rate of triple-vessel disease with greater than 70% stenosis and high rates of multiple CTOs (9% and 14%), he said.
Of those who underwent CTO-PCI, 6 had multiple CTO arteries treated, 124 were treated using an antegrade-only technique, 23 were treated using a retrograde technique, and 5 were treated using Crossboss/Stingray. The self-reported PCI success rates was 80%, but this was downgraded to 72% based on core lab adjudication.
About 10% of ST-segment–elevation myocardial infarction (STEMI) patients have a noninfarct-related artery CTO, but randomized controlled data on management are lacking.
“We don’t know how to treat them or what to do with these patients. What we do know is that the observed mortality in multivessel-disease patients vs. single vessel–disease patients is mainly driven by confirmed total occlusion. Also, the observed reduced LV function in multivessel-disease patients vs. single vessel–disease patients is also mainly driven by chronic total occlusion,” Dr. Henriques said.
“The EXPLORE trial is the first randomized controlled trial on the impact of PCI of CTO on LV function and clinical outcome in post-STEMI patients,” he said.
The findings suggest that CTO-PCI for a post-STEMI CTO located in the LAD may improve LV function and potentially improve clinical outcome in the long term, he concluded.
Dr. Henriques reported receiving grant or research support from Abbott Vascular, Abiomed, Biotronik, and B.Braun.