The effect of revascularization of a chronic total coronary occlusion on electrocardiographic variables. A sub-study of the EXPLORE trial

Dongen, Ivo M. van; Kolk, Maarten; Elias, Joëlle; Meijborg, Veronique M.F.; Coronel, Ruben; Bakker, Jacques M.T. de; Claessen, Bimmer E.; Delewi, Ronak; Ouweneel, Dagmar M.; Scheunhage, Esther M; Schaaf, René J. van der; Suttorp, Maarten-Jan; Bax, Matthijs; Marques, Koen M.; Postema, Pieter G.; Wilde, Arthur A.M.; Henriques, José P.S.

doi:10.1016/j.jelectrocard.2018.07.012

Cited by 10 publications

(14 citation statements)

References 24 publications

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“…At baseline and at 4 months follow‐up in a total of 120 patients, ECGs were analyzed, of whom 14 patients in the FPCI group, 44 patients in the SPCI group, and 62 patients in the NPCI group 12 . At baseline, no differences in ECG parameters were seen between the three groups (Table 4).…”

Section: Resultsmentioning

confidence: 98%

“…Our results demonstrate that there is no significant difference in both QT‐dispersion, QTc‐time, and TpTe‐intervals between the FPCI, SPCI, and NPCI groups at 4 months follow‐up. The effect of SPCI on QT‐dispersion and TpTe‐intervals has been previously evaluated, hinting toward a beneficial effect of PCI compared to optimal medical therapy 12,14 . Moreover, several retrospective cohort trials have evaluated the effect of CTOs and the long‐term risk of cardiac arrhythmogenesis.…”

Section: Discussionmentioning

confidence: 99%

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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

Veelen

Agostoni

et al. 2020

Cathet Cardio Intervent

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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.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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

Kolk

Veelen

Agostoni

et al. 2020

Cathet Cardio Intervent

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“…Hibernating myocardium is vulnerable for electrical instability and VAs, probably due to prolongation of the action potentials and disturbances of the ATP‐initiated calcium currents . Previous assessment of the rest‐ECGs at 4 months in the EXPLORE trial revealed that ECG‐indices suggestive for arrhythmic susceptibility improve after CTO PCI . However, this was not yet studied during exercise.…”

Section: Discussionmentioning

confidence: 99%

“…These hypoxic/ischemic myocardial zones can function as a substrate for malignant ventricular arrhythmias . Revascularization of these ischemic areas might lead to a reduction of the arrhythmic vulnerability, however whether this results in a decrease of ventricular ectopy (VE) during exercise is also unknown. The Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST‐Elevation Myocardial Infarction (EXPLORE) trial was the first randomized study that compared CTO PCI with no‐CTO PCI in STEMI‐patients.…”

Section: Introductionmentioning

confidence: 99%

“…6 These hypoxic/ischemic myocardial zones can function as a substrate for malignant ventricular arrhythmias. 7 Revascularization of these ischemic areas might lead to a reduction of the arrhythmic vulnerability, 8 trial was the first randomized study that compared CTO PCI with no-CTO PCI in STEMI-patients. This study did not show an improvement of the LVEF or left ventricular end-diastolic volume (LVEDV) after CTO PCI, as measured at 4 months follow-up with cardiac magnetic resonance imaging (CMR).…”

Section: Introductionmentioning

confidence: 99%

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Exercise testing after chronic total coronary occlusion revascularization in patients with STEMI and a concurrent CTO: A subanalysis of the EXPLORE‐trial

Veelen

Dongen

Elias

et al. 2019

Cathet Cardio Intervent

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Objectives To assess the effect of chronic total occlusion percutaneous coronary intervention (CTO PCI) on ventricular ectopy (VE) and symptomatology during exercise testing. Background During exercise, the hypoxic myocardium in the CTO‐territory can act as a substrate for VE and could lead to anginal complaints. Methods In the EXPLORE‐trial, 302 ST‐segment elevation myocardial infarction (STEMI)‐patients were randomized to CTO PCI or no‐CTO PCI. For this sub‐study, we analyzed all available exercise electrocardiograms (X‐ECGs) at 4 months follow‐up on symptoms and electrocardiographic parameters. Results A total of 155 X‐ECGs were available, 80 in the CTO PCI group (51.6%) and 75 in the no‐CTO PCI group (48.4%). There were no differences regarding exercised time, achieved endurance, ST‐deviation nor maximum heart‐rate. The percentage of patients experiencing chest‐pain during exercise was lower in the CTO PCI group (0% vs. 8.5%, p = .03). Also, there was a trend towards a higher maximum systolic blood pressure (SBP, 185 mmHg vs. 175, p = .09). No difference in VE was found between randomization groups, but patients with successful CTO PCI had a higher frequency of VE, compared to failed and no‐CTO PCI (26% vs. 8%, p = .02). This did not result in higher frequencies of sustained ventricular arrhythmias or mortality. Conclusion In conclusion, in STEMI‐patients, CTO PCI is associated with a small reduction of chest‐pain during exercise and tended to be associated with an increase of maximum SBP. The observation that successful CTO PCI was associated with more VE during exercise, compared with failed/no‐CTO PCI needs further exploration.

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Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing Coronary Artery Bypass Grafting

Arjomandi Rad,

Tserioti,

Magouliotis

et al. 2024

Clinical Cardiology

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BackgroundWe aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG.MethodsA systematic database search with meta‐analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single‐photon emission computed tomography (SPECT), and positron emission tomography (PET).ResultsA total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post‐CABG was reduced in patients with versus without viability (random‐effects model: odds ratio: 0.42; 95% confidence interval: 0.29–0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.ConclusionThe assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.

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The effect of revascularization of a chronic total coronary occlusion on electrocardiographic variables. A sub-study of the EXPLORE trial

Abstract: Revascularization of a CTO after STEMI significantly shortened QT dispersion at 4 months follow-up. These findings support the hypothesis that CTO revascularization reduces the pro-arrhythmic substrate in CTO patients.

Cited by 10 publications

References 24 publications

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

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

Exercise testing after chronic total coronary occlusion revascularization in patients with STEMI and a concurrent CTO: A subanalysis of the EXPLORE‐trial

Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing Coronary Artery Bypass Grafting

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The effect of revascularization of a chronic total coronary occlusion on electrocardiographic variables. A sub-study of the EXPLORE trial

Abstract: Revascularization of a CTO after STEMI significantly shortened QT dispersion at 4 months follow-up. These findings support the hypothesis that CTO revascularization reduces the pro-arrhythmic substrate in CTO patients.

Cited by 10 publications

References 24 publications

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

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

Exercise testing after chronic total coronary occlusion revascularization in patients with STEMI and a concurrent CTO: A subanalysis of the EXPLORE‐trial

Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing Coronary Artery Bypass Grafting

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Product

Resources

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Abstract: Revascularization of a CTO after STEMI significantly shortened QT dispersion at 4 months follow-up. These findings support the hypothesis that CTO revascularization reduces the pro-arrhythmic substrate in CTO patients.