Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion—A subanalysis of the EXPLORE trial

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Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion—A subanalysis of the EXPLORE trial. / Kolk, Maarten Z. H.; van Veelen, Anna; Agostoni, Pierfrancesco et al.

In: Catheterization and cardiovascular interventions, Vol. 97, No. 6, 01.05.2021, p. 1176-1183.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{5351184daee54652bfa8ad6b8758fea5,

title = "Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion—A subanalysis of the EXPLORE trial",

abstract = "Objective: To evaluate predictors of procedural success of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) in a non-infarct-related artery following ST-segment elevation myocardial infarction (STEMI), and demonstrate the effect on left ventricular functionality (LVF), infarct size (IS), and pro-arrhythmic electrocardiogram (ECG) parameters. Background: Predictors of unsuccessful revascularization of a CTO are numerous, although following STEMI, these are lacking. Besides, effects of failed CTO PCI (FPCI) on the myocardium are unknown. Methods: This is a subanalysis of the EXPLORE trial, in which 302 STEMI patients with a concurrent CTO were randomized to CTO PCI (n = 147) or no-CTO PCI (NPCI, n = 154). For the purpose of this subanalysis, we divided patients into successful CTO PCI (SPCI, n = 106), FPCI (n = 41), and NPCI (n = 154) groups. Cardiac magnetic resonance imaging and angiographic data were derived from the EXPLORE database, combined with ECG parameters. To gain more insight, all outcomes were compared with patients that did not undergo CTO PCI. Results: In multivariate regression, only CTO lesion length >20 mm was an independent predictor of procedural failure (OR 3.31 [1.49–7.39]). No significant differences in median left ventricular ejection fraction, left ventricular end-diastolic volume, IS, and the pro-arrhythmic ECG parameters such as QT-dispersion, QTc-time, and TpTe-intervals were seen between the SPCI and FPCI groups at 4 months follow-up. Conclusion: This subanalysis of the EXPLORE trial has demonstrated that a CTO lesion length >20 mm is an independent predictor of CTO PCI failure, whereas procedural failure did not lead to any adverse effects on LVF nor pro-arrhythmic ECG parameters.",

keywords = "CMR, CTO, ECG, PCI, STEMI",

author = "Kolk, {Maarten Z. H.} and {van Veelen}, Anna and Pierfrancesco Agostoni and {van Houwelingen}, {Gert K.} and Ouweneel, {Dagmar M.} and Hoebers, {Loes P.} and Truls R{\aa}munddal and Peep Laanmets and Erlend Eriksen and Matthijs Bax and Suttorp, {Maarten J.} and Claessen, {Bimmer E. P. M.} and {van der Schaaf}, {Ren{\'e} J.} and Jo{\"e}lle Elias and {van Dongen}, {Ivo M.} and Henriques, {Jos{\'e} P. S.}",

note = "Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC.",

year = "2021",

month = may,

day = "1",

doi = "10.1002/ccd.28904",

language = "English",

volume = "97",

pages = "1176--1183",

journal = "Catheterization and cardiovascular interventions",

issn = "1522-1946",

publisher = "Wiley-Liss Inc.",

number = "6",

}

RIS

TY - JOUR

T1 - Predictors and outcomes of procedural failure of percutaneous coronary intervention of a chronic total occlusion—A subanalysis of the EXPLORE trial

AU - Kolk, Maarten Z. H.

AU - van Veelen, Anna

AU - Agostoni, Pierfrancesco

AU - van Houwelingen, Gert K.

AU - Ouweneel, Dagmar M.

AU - Hoebers, Loes P.

AU - Råmunddal, Truls

AU - Laanmets, Peep

AU - Eriksen, Erlend

AU - Bax, Matthijs

AU - Suttorp, Maarten J.

AU - Claessen, Bimmer E. P. M.

AU - van der Schaaf, René J.

AU - Elias, Joëlle

AU - van Dongen, Ivo M.

AU - Henriques, José P. S.

PY - 2021/5/1

Y1 - 2021/5/1

N2 - Objective: To evaluate predictors of procedural success of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) in a non-infarct-related artery following ST-segment elevation myocardial infarction (STEMI), and demonstrate the effect on left ventricular functionality (LVF), infarct size (IS), and pro-arrhythmic electrocardiogram (ECG) parameters. Background: Predictors of unsuccessful revascularization of a CTO are numerous, although following STEMI, these are lacking. Besides, effects of failed CTO PCI (FPCI) on the myocardium are unknown. Methods: This is a subanalysis of the EXPLORE trial, in which 302 STEMI patients with a concurrent CTO were randomized to CTO PCI (n = 147) or no-CTO PCI (NPCI, n = 154). For the purpose of this subanalysis, we divided patients into successful CTO PCI (SPCI, n = 106), FPCI (n = 41), and NPCI (n = 154) groups. Cardiac magnetic resonance imaging and angiographic data were derived from the EXPLORE database, combined with ECG parameters. To gain more insight, all outcomes were compared with patients that did not undergo CTO PCI. Results: In multivariate regression, only CTO lesion length >20 mm was an independent predictor of procedural failure (OR 3.31 [1.49–7.39]). No significant differences in median left ventricular ejection fraction, left ventricular end-diastolic volume, IS, and the pro-arrhythmic ECG parameters such as QT-dispersion, QTc-time, and TpTe-intervals were seen between the SPCI and FPCI groups at 4 months follow-up. Conclusion: This subanalysis of the EXPLORE trial has demonstrated that a CTO lesion length >20 mm is an independent predictor of CTO PCI failure, whereas procedural failure did not lead to any adverse effects on LVF nor pro-arrhythmic ECG parameters.

AB - Objective: To evaluate predictors of procedural success of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) in a non-infarct-related artery following ST-segment elevation myocardial infarction (STEMI), and demonstrate the effect on left ventricular functionality (LVF), infarct size (IS), and pro-arrhythmic electrocardiogram (ECG) parameters. Background: Predictors of unsuccessful revascularization of a CTO are numerous, although following STEMI, these are lacking. Besides, effects of failed CTO PCI (FPCI) on the myocardium are unknown. Methods: This is a subanalysis of the EXPLORE trial, in which 302 STEMI patients with a concurrent CTO were randomized to CTO PCI (n = 147) or no-CTO PCI (NPCI, n = 154). For the purpose of this subanalysis, we divided patients into successful CTO PCI (SPCI, n = 106), FPCI (n = 41), and NPCI (n = 154) groups. Cardiac magnetic resonance imaging and angiographic data were derived from the EXPLORE database, combined with ECG parameters. To gain more insight, all outcomes were compared with patients that did not undergo CTO PCI. Results: In multivariate regression, only CTO lesion length >20 mm was an independent predictor of procedural failure (OR 3.31 [1.49–7.39]). No significant differences in median left ventricular ejection fraction, left ventricular end-diastolic volume, IS, and the pro-arrhythmic ECG parameters such as QT-dispersion, QTc-time, and TpTe-intervals were seen between the SPCI and FPCI groups at 4 months follow-up. Conclusion: This subanalysis of the EXPLORE trial has demonstrated that a CTO lesion length >20 mm is an independent predictor of CTO PCI failure, whereas procedural failure did not lead to any adverse effects on LVF nor pro-arrhythmic ECG parameters.

KW - CMR

KW - CTO

KW - ECG

KW - PCI

KW - STEMI

UR - http://www.scopus.com/inward/record.url?scp=85083464383&partnerID=8YFLogxK

U2 - 10.1002/ccd.28904

DO - 10.1002/ccd.28904

M3 - Article

C2 - 32294316

VL - 97

SP - 1176

EP - 1183

JO - Catheterization and cardiovascular interventions

JF - Catheterization and cardiovascular interventions

SN - 1522-1946

IS - 6

ER -

ID: 11436622

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