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Percutaneous Coronary Intervention Did Not Reduce the Occurrence of Death, Reinfarction, or Heart Failure in Patients with Occlusion of the Infarct-Related Artery 3 to 28 Days after Myocardial Infarction

November 22, 2006

By Sahar Bedrood B.S. and Asher Kimchi M.D.

New York, NY - Current treatment of acute myocardial infarction (MI) with ST-segment elevation includes early reperfusion with primary percutaneous coronary intervention (PCI). For patients with persistent total occlusion of the infarct-related artery who have been identified after the currently accepted period during which reperfusion is administered, the best strategy for care has been unclear until now.  Judith Hochman M.D., et al from the New York University School of Medicine, conducted a 4 year study showing that PCI did not reduce the occurrence of death, reinfarction or heart failure in patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction. The article was published in the November 14, 2006 issue of The New England Journal of Medicine.

A randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high risk criterion was done. Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy and 1084 were assigned to optimal medical therapy alone.

The 4 year cumulative primary event rate was 17.2% in the PCI group and 15.6% in the medical therapy group (hazard ratio, 1.16; 95% CI, 0.92 to 1.45, P=0.20). Rates of myocardial reinfarction were 7.0% and 5.3 % in the two groups, respectively. (Hazard ratio, 1.36; 95% CI, 0.92 to 2.0, P= 0.13). Rates of nonfatal reinfarction were 6.9% and 5.0%, respectively (hazard ratio, 1.44; 95% CI, 0.96 to 2.16; P=0.08); only six reinfarctions (0.6%) were related to assigned PCI procedures. Rates of New York Heart Association class IV heart failure were 4.4% vs. 4.5%, respectively. Rates of death were 9.1% vs. 9.4% respectively.

The study concluded that PCI did not reduce the occurrence of death, reinfarction, or heart failure and there was a trend toward excess reinfarction during 4 years of follow-up in stable patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction.

Co-authors: Judith S. Hochman, M.D., Gervasio A. Lamas, M.D., Christopher E. Buller, M.D., Vladimir Dzavik, M.D., Harmony R. Reynolds, M.D., Staci J. Abramsky, M.P.H., Sandra Forman, M.A., Witold Ruzyllo, M.D., Aldo P. Maggioni, M.D., Harvey White, M.D., Zygmunt Sadowski, M.D., Antonio C. Carvalho, M.D., Jamie M. Rankin, M.D., Jean P. Renkin, M.D., P. Gabriel Steg, M.D., Alice M. Mascette, M.D., George Sopko, M.D., Matthias E. Pfisterer, M.D., Jonathan Leor, M.D., Viliam Fridrich, M.D., Daniel B. Mark, M.D., M.P.H., Genell L. Knatterud, Ph.D., for the Occluded Artery Trial Investigators

 


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