{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:18:27Z","timestamp":1792700307492,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"17","funder":[{"DOI":"10.13039\/100011949","name":"Abbott Vascular","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011949","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,1,13]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The median long-term follow-up was 3.9 (2.1\u20135.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95%\u2009CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95%\u2009CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1\u2009year (94% vs 87%, P=0.03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>EXPLORE trial number NTR1108 <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"www.trialregister.nl.\" ext-link-type=\"uri\">www.trialregister.nl.<\/jats:ext-link>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-312698","type":"journal-article","created":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T12:18:32Z","timestamp":1519129112000},"page":"1432-1438","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":66,"title":["Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction"],"prefix":"10.1136","volume":"104","clinical-trial-number":[{"clinical-trial-number":"nct02784418","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jo\u00eblle","family":"Elias","sequence":"first","affiliation":[{"name":"Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo M","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Truls","family":"R\u00e5munddal","sequence":"additional","affiliation":[{"name":"Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peep","family":"Laanmets","sequence":"additional","affiliation":[{"name":"North-Estonia Medical Centre, Talinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erlend","family":"Eriksen","sequence":"additional","affiliation":[{"name":"Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Meuwissen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amphia Hospital, Breda, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H Rolf","family":"Michels","sequence":"additional","affiliation":[{"name":"Catharina Hospital, Eindhoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs","family":"Bax","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Ioanes","sequence":"additional","affiliation":[{"name":"Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Jan","family":"Suttorp","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley H","family":"Strauss","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Barbato","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Onze Lieve Vrouwe Ziekenhuis, Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen M","family":"Marques","sequence":"additional","affiliation":[{"name":"VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bimmer E P M","family":"Claessen","sequence":"additional","affiliation":[{"name":"Department of 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