Title |
Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial
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Published in |
Critical Reviews in Diagnostic Imaging, July 2017
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DOI | 10.1186/s12968-017-0369-z |
Pubmed ID | |
Authors |
Joëlle Elias, Ivo M. van Dongen, Loes P. Hoebers, Dagmar M. Ouweneel, Bimmer E. P.M. Claessen, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, René J. van der Schaaf, Dan Ioanes, Robin Nijveldt, Jan G. Tijssen, Alexander Hirsch, José P.S. Henriques, on behalf of the EXPLORE investigators |
Abstract |
The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment. In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2-3 collaterals compared to grade 0-1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04). CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007. |
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Country | Count | As % |
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United States | 9 | 41% |
United Kingdom | 3 | 14% |
Colombia | 1 | 5% |
Ireland | 1 | 5% |
Canada | 1 | 5% |
Portugal | 1 | 5% |
Unknown | 6 | 27% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 13 | 59% |
Scientists | 5 | 23% |
Practitioners (doctors, other healthcare professionals) | 3 | 14% |
Science communicators (journalists, bloggers, editors) | 1 | 5% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 59 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 7 | 12% |
Student > Postgraduate | 7 | 12% |
Student > Master | 6 | 10% |
Researcher | 5 | 8% |
Student > Ph. D. Student | 4 | 7% |
Other | 10 | 17% |
Unknown | 20 | 34% |
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Medicine and Dentistry | 23 | 39% |
Nursing and Health Professions | 5 | 8% |
Agricultural and Biological Sciences | 1 | 2% |
Psychology | 1 | 2% |
Immunology and Microbiology | 1 | 2% |
Other | 2 | 3% |
Unknown | 26 | 44% |