Long-Term Effects of Percutaneous Coronary Intervention of the Totally Occluded Infarct-Related Artery in the Subacute Phase After Myocardial Infarction

Study Questions:

What is the long-term impact of percutaneous coronary intervention (PCI) performed on totally occluded vessels in patients with recent myocardial infarction (days 3-28)?

Methods:

The authors reported the long-term follow-up of the OAT (Occluded Artery Trial) study. This trial randomized 2,201 stable patients with infarct-related artery total occlusion >24 hours after myocardial infarction to PCI or medical therapy. Patients with severe inducible ischemia, rest angina, class III-IV heart failure, and three-vessel or left main disease were excluded. The median survival among survivors was 6 years, with the longest survival being 9 years.

Results:

There was no difference in the composite of death, reinfarction, and class IV heart failure (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.88-1.28), fatal and nonfatal myocardial infarction (HR, 1.25; 95% CI, 0.89-1.75), death, or class IV heart failure between the two arms. No subgroup was identified that was associated with better (or worse) outcome with either therapy. The vast majority of patients at each follow-up visit did not report angina. There was less angina in the PCI group, with the difference being attenuated with time. The 7-year rate of PCI of the infarct-related artery during follow-up was 11.1% for the PCI group compared with 14.7% for the medical therapy alone group (HR, 0.79; 95% CI, 0.61-1.01; p = 0.06).

Conclusions:

The authors concluded that late PCI (more than 24 hours) of a totally occluded infarct-related artery is not associated with any clinical benefit.

Perspective:

This follow-up analysis from OAT clearly establishes the lack of clinical benefit of routine PCI for patients with an occluded infarct-related artery late after a myocardial infarction. A recent study demonstrated a low, but consistent use of PCI in this population (Deyell et al., Arch Intern Med 2011;171:1636-43). The consistently negative findings of this study should serve to further reduce the use of PCI in this population.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Survivors, Heart Diseases, Myocardial Infarction, Follow-Up Studies, Avena sativa, Death, Cardiovascular Diseases, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention


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