European Heart Journal Advance Access published online on November 21, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn486
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Lack of benefit from percutaneous intervention of persistently occluded infarct arteries after the acute phase of myocardial infarction is time independent: insights from Occluded Artery Trial
1 Division of Cardiology, F-15, 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 4419, USA
2 New York University School of Medicine, New York, NY, USA
3 Vancouver General Hospital, Vancouver, BC, Canada
4 Centre Hospitalier Bichat–Claude Bernard, Université Paris VII–Denis Diderot, Paris (P.G.S.), France
5 Maryland Medical Research Institute, Baltimore, MD, USA
6 Green Lane Cardiovascular Service, Auckland, New Zealand
7 University of Verona/Istituti Ospedalieri, Verona, Italy
8 Athens Euroclinic, Athens, Greece
9 Hospital São Lucas-Pontifícia University Católica do Rio Grande do Sul, Porto Alegre, Brazil
10 Hospital São Lucas-Pontifícia, University Católica do Rio Grande do Sul, Porto Alegre, Brazil
11 Medical University of Wroclaw, T. Marciniak Hospital, Wroclaw, Poland
12 Silesian Center for Cardiology, Katowice-Ochojec, Poland
13 University of Miami Miller School of Medicine, Miami, FL, USA
Received 19 June 2008; revised 2 October 2008; accepted 9 October 2008.
* Corresponding author. Tel: +1 216 445 5390, Fax: +1 216 636 0679, Email: menonv{at}ccf.org
Aims: The Occluded Artery Trial (OAT) (n = 2201) showed no benefit for routine percutaneous intervention (PCI) (n = 1101) over medical therapy (MED) (n = 1100) on the combined endpoint of death, myocardial infarction (MI), and class IV heart failure (congestive heart failure) in stable post-MI patients with late occluded infarct-related arteries (IRAs). We evaluated the potential for selective benefit with PCI over MED for patients enrolled early in OAT.
Methods and results: We explored outcomes with PCI over MED in patients randomized to the 
3 calendar days and 7 calendar days post-MI time windows. Earlier, times to randomization in OAT were associated with higher rates of the combined endpoint (adjusted HR 1.04/day: 99% CI 1.01–1.06; P < 0.001). The 48-month event rates for 3 days, 7 days post-MI enrolled patients were similar for PCI vs. MED for the combined and individual endpoints. There was no interaction between time to randomization defined as a continuous (P = 0.55) or categorical variable with a cut-point of 3 days (P = 0.98) or 7 days (P = 0.64) post-MI and treatment effect.
Conclusion: Consistent with overall OAT findings, patients enrolled in the 3 day and 7 day post-MI time windows derived no benefit with PCI over MED with no interaction between time to randomization and treatment effect. Our findings do not support routine PCI of the occluded IRA in trial-eligible patients even in the earliest 24–72 h time window.
Key Words: Coronary artery disease • Myocardial infarction • Percutaneous intervention
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  K. C. Wu Variation on a Theme: CMR as the "One-Stop Shop" for Risk Stratification After Infarction? J. Am. Coll. Cardiol. Img., July 1, 2009; 2(7): 843 - 845. [Full Text] [PDF]
|
|
|
|
 |
|
 Did Time to Randomization Affect the OAT Results? Journal Watch Cardiology, February 25, 2009; 2009(225): 3 - 3. [Full Text]
|
|
|
|
 |
|
 H.C. Lowe and S.B. Freedman The late open artery hypothesis: the case and the artery remain closed Eur. Heart J., January 2, 2009; 30(2): 129 - 130. [Full Text] [PDF]
|
|