Trial reportJournal of the American Heart Association2024
Ten-Year Outcome of Recanalization or Medical Therapy for Concomitant Chronic Total Occlusion After Myocardial Infarction.
Trial report in Journal of the American Heart Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Long-Term Survival and Angina After Chronic Total Occlusion Percutaneous Coronary Intervention Compared With Medical Therapy: A Meta-Analysis.Journal of the American Heart Association · 2024Pooled it
- Lipoprotein(a) and Adverse Outcomes After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion: A Single-Center Retrospective Cohort Study.Journal of cardiovascular development and disease · 2026Article
- Intravascular lithotripsy for coronary chronic total occlusion: a meta-analysis of procedural and clinical outcomes.AsiaIntervention · 2026Article
- Complex CTO Revascularization in Patients with Ischemic Heart Failure and Reduced Ejection Fraction: An Illustrative Case Series.Journal of clinical medicine · 2026Article
- CTO PCI vs. medical therapy in stable CAD: real-world outcomes from a target trial emulation of SCAAR registry data.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Association between neutrophil percentage-to-albumin ratio and adverse clinical outcomes after successful percutaneous coronary intervention for chronic total occlusion: a cohort study.Frontiers in immunology · 2026Article
- The Role of Myocardial Revascularization in Ischemic Heart Failure in the Era of Modern Optimal Medical Therapy.Medicina (Kaunas, Lithuania) · 2025Review
- Chronic Total Occlusions: Current Approaches, Evidence and Outcomes.Journal of clinical medicine · 2025Review
- Impella-Protected High-Risk Percutaneous Coronary Intervention in the Elderly: Balancing Feasibility and Necessity.Journal of the American Heart Association · 2025Article
- Chronic Total Occlusions in Non-Infarct-Related Coronary Arteries and Long-Term Cardiovascular Mortality in Patients Receiving Percutaneous Coronary Intervention in Acute Coronary Syndromes.Journal of clinical medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe EXPLORE (Evaluating Xience and Left Ventricular Function in PCI on Occlusions After STEMI) trial was the first and only randomized trial investigating chronic total occlusion (CTO) percutaneous coronary intervention (PCI) early after primary PCI for ST-segment-elevation myocardial infarction, compared with medical therapy for the CTO. We performed a 10-year follow-up of EXPLORE to investigate long-term safety and clinical impact of CTO PCI after ST-segment-elevation myocardial infarction, compared with no-CTO PCI. METHODS AND
resultsIn EXPLORE, 302 patients post-ST-segment-elevation myocardial infarction with concurrent CTO were randomized to CTO PCI within ≈1 week or no-CTO PCI. We performed an extended clinical follow-up for the primary end point of major adverse cardiac events, consisting of cardiovascular death, coronary artery bypass grafting, or myocardial infarction. Secondary end points included all-cause death, angina, and dyspnea. Median follow-up was 10 years (interquartile range, 8-11 years). The primary end point occurred in 25% of patients with CTO PCI and in 24% of patients with no-CTO PCI (hazard ratio [HR], 1.11 [95% CI, 0.70-1.76]). Cardiovascular mortality was higher in the CTO PCI group (HR, 2.09 [95% CI, 1.10-2.50]), but all-cause death was similar (HR, 1.53 [95% CI, 0.93-2.50]). Dyspnea relief was more frequent after CTO PCI (83% versus 65%,
conclusionsThis 10-year follow-up of patients post-ST-segment-elevation myocardial infarction randomized to CTO PCI or no-CTO PCI demonstrated no clinical benefit of CTO PCI in major adverse cardiac events or overall mortality. However, CTO PCI was associated with a higher cardiovascular mortality compared with no-CTO PCI. Our long-term data support a careful weighing of effective symptom relief against an elevated cardiovascular mortality risk in CTO PCI decisions. REGISTRATION: URL: https://www.trialregister.nl; Unique identifier: NTR1108.
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