Ten-Year Outcome of Recanalization or Medical Therapy for Concomitant Chronic Total Occlusion After Myocardial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• The EXPLORE trial was the first randomized trial comparing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with medical therapy early after ST-segment-elevation myocardial infarction (STEMI).
• This study presents a 10-year follow-up of the EXPLORE trial to assess the long-term safety and clinical impact of CTO PCI versus no-CTO PCI.

Purpose of the Study:

• To investigate the long-term safety and clinical outcomes of CTO PCI in patients with STEMI.
• To compare major adverse cardiac events, mortality, angina, and dyspnea between CTO PCI and no-CTO PCI groups over a 10-year period.

Main Methods:

• A 10-year extended clinical follow-up of the 302 patients randomized in the EXPLORE trial.
• Primary endpoint: major adverse cardiac events (cardiovascular death, coronary artery bypass grafting, myocardial infarction).
• Secondary endpoints: all-cause death, angina, and dyspnea.

Main Results:

• No significant difference in the primary endpoint of major adverse cardiac events between CTO PCI (25%) and no-CTO PCI (24%) groups (HR, 1.11).
• Cardiovascular mortality was higher in the CTO PCI group (HR, 2.09), while all-cause death was similar.
• Dyspnea relief was significantly more frequent in the CTO PCI group (83% vs. 65%, P=0.005), with no difference in angina.

Conclusions:

• Long-term CTO PCI after STEMI does not provide clinical benefit regarding major adverse cardiac events or overall mortality.
• CTO PCI is associated with increased cardiovascular mortality but offers significant dyspnea relief.
• Clinical decisions regarding CTO PCI should carefully weigh symptom relief against the elevated risk of cardiovascular mortality.