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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
Author(s) -
Kolk Maarten Z. H.,
Veelen Anna,
Agostoni Pierfrancesco,
Houwelingen Gert K.,
Ouweneel Dagmar M.,
Hoebers Loes P.,
Råmunddal Truls,
Laanmets Peep,
Eriksen Erlend,
Bax Matthijs,
Suttorp Maarten J.,
Claessen Bimmer E. P. M.,
Schaaf René J.,
Elias Joëlle,
Dongen Ivo M.,
Henriques José P. S.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28904
Subject(s) - medicine , conventional pci , cardiology , percutaneous coronary intervention , ejection fraction , myocardial infarction , revascularization , heart failure
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.