Copyright © 2004 by the European Society of Cardiology.
Clinical research
DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction
a Department of Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
b Department of Cardiology, Hôpital Fontenoy, Chartres, France
c Department of Cardiology, Hôpital de Rangueil, Toulouse-Rangueil, France
d Departments of Cardiology, Hôpital Henri Mondor, Créteil, France
e Department of Cardiology, Hôpital La Milétrie, Poitiers, France
f Department of Cardiology, Hôpital N.D. de Bon Secours, Metz, France
g Department of Cardiology, C.H. Bretagne Sud, Lorient, France
h Department of Cardiology, Hôpital Beaujon, Clichy, France
i Department of Cardiology, Hôpital Antoine Béclère, Clamart, France
j Department of Cardiology, Hôpital Cochin, Paris, France
k Department of Cardiology, Hôpital Saint-Antoine, Paris, France
l Department of Cardiology, Hôpital Laennec, Nantes, France
m Department of Cardiology, Hôpital R. Ballanger, Aulnay-sous-Bois, France
n Department of Cardiology, Hôpital Adulte de Brabois, Nancy, France
o Department of Cardiology, Hôpital Tenon, Paris, France
p Department of Cardiology, O.L.V. Ziekenhuis, Aalst, France
q Department of Biostatistics and Medical Information, Hôpital Henri Mondor, Créteil, France
r Department of Biostatistics and Medical Information, Hôpital, Saint-Louis, Paris, France
Received 2 July 2004; revised 27 September 2004; accepted 5 October 2004 * Corresponding author. Tel.: +33 1 40 25 86 68; fax: +33 1 40 25 88 65 (E-mail: gabriel.steg{at}bch.ap-hop-paris.fr).
See page 2177 for the editorial comment on this article (doi:10.1016/j.ehj.2004.10.002)
AIM: To determine whether late recanalization of an occluded infarct artery after acute myocardial infarction is beneficial.
METHODS AND RESULTS: Two hundred and twelve patients with a first Q-wave myocardial infarction (MI) and an occluded infarct vessel were enrolled. After coronary and left ventricular contrast angiography, patients were randomized to percutaneous revascularization (PTCA, n=109), carried out 2–15 days after symptom onset or medical therapy (n=103). The primary endpoint was a composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia. The majority had single-vessel disease and less than one-third had involvement of the left anterior descending artery. The use of pharmacological therapy was high in both groups. At six months, left ventricular ejection fraction was 5% higher in the invasive compared with the medical group (P=0.013) and more patients had a patent artery (82.8% vs 34.2%, P<0.0001). Restenosis was seen in 49.4% of patients in the PTCA group. At a mean of 34 months of follow-up, the occurrence of the primary endpoint was similar in the medical and PTCA groups (8.7% vs 7.3% respectively, P=0.68), but the overall costs were higher for PTCA. The secondary endpoint combining the primary endpoint with admission for heart failure was also similar between groups (12.6% vs 10.1% in the medical and PTCA groups, respectively, P=0.56).
CONCLUSIONS: Systematic late PTCA of the infarct vessel was associated with a higher left ventricular ejection fraction at six months, no difference in clinical outcomes, and higher costs than medical therapy. These results must be interpreted with caution given the small size and low risk of the population.
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