Exploring the role of percutaneous coronary intervention for chronic total occlusions

A chronic total occlusion (CTO) is the most extreme form of coronary artery disease (CAD). Patients with a CTO have a worse clinical outcome compared to non-CTO patients, irrespective of age or other co-morbidities. Especially patients presenting with a ST-segment elevation myocardial infarction (STEMI), in whom (accidently) a concurrent CTO is found, have increased morbidity and mortality. In contrary invasive treatment of CTO lesions is infrequently performed. The question whether routine early percutaneous coronary intervention (PCI) of the concurrent CTO after successful primary PCI for STEMI will lead to improved outcome is the main endpoint of the Evaluating Xience and LV Function in PCI on Occlusions After STEMI (EXPLORE) trial. The thesis presented here is an in-depth exploration of this important question.