Coronary Intervention for Persistent Occlusion after Myocardial Infarction
Why the study?
Does routine PCI and stenting reduce the composite of death, reinfarction, or NYHA class IV heart failure in stable patients with persistent total occlusion of the infarct-related artery 3 to 28 days after MI?
Population
2166 stable patients with total occlusion of the infarct-related artery 3 to 28 days after myocardial…
Comparison
Routine percutaneous coronary intervention and… vs Optimal medical therapy alone
Design
RCT, randomized
Follow-up
4 years
Authors
Discussion
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Implication
Routine PCI confers no benefit for late persistent occlusion post-MI; confirms medical therapy alone as standard in stable patients.
Key Points
- The study aims to determine the effectiveness of PCI combined with optimal medical therapy in reducing adverse cardiac events in high-risk patients with total occlusion post-heart attack.
- Randomized study involving 2166 high-risk stable patients with total occlusion 3 to 28 days after myocardial infarction.
- Patients were assigned to either PCI with stenting or optimal medical therapy alone.
- Primary endpoint focused on composite outcomes including death, reinfarction, and class IV heart failure.
- The 4-year cumulative primary event rates were 17.2% for PCI and 15.6% for medical therapy (HR 1.16, 95% CI 0.92-1.45, P=0.20).
- Reinfarction rates were 7.0% for PCI and 5.3% for medical therapy (HR 1.36, 95% CI 0.92-2.00, P=0.13).
- NYHA class IV heart failure rates were similar (4.4% vs. 4.5%), as were death rates (9.1% vs. 9.4%).
Structured PICO
Does routine PCI and stenting reduce the composite of death, reinfarction, or NYHA class IV heart failure in stable patients with persistent total occlusion of the infarct-related artery 3 to 28 days after MI?
P
Population
2166 stable patients with total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and high-risk criteria (ejection fraction <50% or proximal occlusion).
I
Intervention
Routine percutaneous coronary intervention (PCI) and stenting added to optimal medical therapy
C
Comparator
Optimal medical therapy alone
O
Outcome
Composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure at 4 yearscomposite
Routine PCI for persistent total occlusion of the infarct-related artery 3 to 28 days after MI does not reduce the risk of death, reinfarction, or severe heart failure compared to medical therapy alone.
Cite This Study
Hochman et al. (2006) studied this question.