What does this research mean for the field?

Early PCI of a concurrent chronic total occlusion following primary PCI for STEMI does not significantly improve left ventricular ejection fraction or end-diastolic volume at 4 months compared with conservative treatment. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether performing early percutaneous coronary intervention on a non-infarct-related chronic total occlusion improves cardiac function and remodeling in patients presenting with STEMI.

September 14, 2026Journal of the American College of CardiologyOpen Access

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI

Q: What is the clinical evidence from this study?

Study design: RCT. Population: ST-segment elevation myocardial infarction (STEMI) with concurrent chronic total occlusion (CTO) (n=304). Intervention: Early PCI of the CTO vs. Conservative treatment without PCI of the CTO. Primary outcome: Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac magnetic resonance imaging after 4 months (p=0.60).

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Key result

Early CTO PCI after STEMI fails to improve LVEF or LVEDV versus conservative treatment.

P=0.60
n=304

Why the study?

Concurrent CTO in a non-infarct-related artery occurs in 10% to 15% of STEMI patients and increases morbidity and mortality, but whether additional CTO PCI shortly after primary PCI improves outcomes was unknown.

Population

304 acute STEMI patients with concurrent CTO after primary PCI across 14 centers

Comparison

Early CTO PCI vs conservative treatment without CTO PCI

Design

Multicenter randomized trial

Follow-up

4 months

Authors

JHJosé P.S. HenriquesInterventional Cardiology JHJosé P.S. HenriquesInterventional Cardiology LHLoes P. HoebersVieCuri Medisch Centrum

Discussion

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Implication

Routine early CTO PCI after STEMI with concurrent non-IRA CTO was not associated with improved LVEF or LVEDV; leaves open potential LAD subgroup benefit for prospective confirmation.

Key Points

To evaluate whether performing early percutaneous coronary intervention on a non-infarct-related chronic total occlusion improves cardiac function and remodeling in patients presenting with STEMI.
Multicenter randomized trial (EXPLORE, NTR1108) conducted across 14 centers in Europe and Canada enrolling 304 acute STEMI patients with concurrent chronic total occlusion (CTO) after primary percutaneous coronary intervention (PCI).
Patients were randomized to early CTO PCI within one week (n = 150) or conservative medical therapy without CTO PCI (n = 154).
Primary endpoints of left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) were assessed via cardiac magnetic resonance imaging at 4 months.
At 4 months, mean LVEF did not differ between the CTO PCI group and the conservative group (44.1 ± 12.2% vs. 44.8 ± 11.9%; p = 0.60).
Mean LVEDV at 4 months was 215.6 ± 62.5 ml in the CTO PCI arm versus 212.8 ± 60.3 ml in the no-CTO PCI arm (p = 0.70), with major adverse coronary event rates of 5.4% versus 2.6% (p = 0.25).
In a subgroup analysis, patients with a CTO in the left anterior descending coronary artery had significantly higher LVEF with CTO PCI compared to conservative treatment (47.2 ± 12.3% vs. 40.4 ± 11.9%; p = 0.02).

Study Design

Type

RCT (n=304)

Randomization

randomly assigned

Multicenter

Yes

PICO

Population

304 patients with acute STEMI who underwent primary PCI and had concurrent CTO in a non-infarct-related artery, followed for 4 months.

Intervention / Comparator

Early PCI of the CTO vs Conservative treatment without PCI of the CTO

Primary Outcome

Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac magnetic resonance imaging after 4 months, p=0.60

Main Result

Absolute Event Rate: 44.1% vs 44.8%

p-value: p=0.60

Cite This Study

Henriques et al. (2016) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) with concurrent chronic total occlusion (CTO) (n=304). Early PCI of the CTO vs. Conservative treatment without PCI of the CTO was evaluated on Left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac magnetic resonance imaging after 4 months (p=0.60). Early PCI of a concurrent chronic total occlusion after primary PCI for STEMI did not significantly improve mean LVEF (44.1% vs. 44.8%; p=0.60) or LVEDV at 4 months compared to conservative treatment.

synapsesocial.com/papers/6aa831eefba307c799b34425 https://doi.org/10.1016/j.jacc.2016.07.744

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Implication

Routine early CTO PCI after STEMI with concurrent non-IRA CTO was not associated with improved LVEF or LVEDV; leaves open potential LAD subgroup benefit for prospective confirmation.

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Main Result

Cite This Study

Also Consider

Also Consider