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

Anna van Veelen, Ivo M. van Dongen, Joëlle Elias, Truls Råmunddal, Erlend Eriksen, René J. van der Schaaf, Bimmer E.P.M. Claessen, Pieter G. Postema, José P.S. Henriques

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)536-545
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume94
Issue number4
DOIs
StatePublished - 1 Oct 2019

Keywords

  • ST-segment elevation myocardial infarction
  • chronic total occlusion
  • exercise test
  • percutaneous coronary intervention

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