PCI with stenting of a persistently occluded infarct-related artery 3-28 days post-MI improved 1-year patency (83% vs 25%, P<0.001) but did not improve LV ejection fraction (P=0.47).
RCT (n=381)
Does percutaneous coronary intervention with stenting improve IRA patency and LV ejection fraction in patients with an occluded native infarct-related artery 3 to 28 days after MI?
PCI of a persistently occluded infarct-related artery in the subacute phase after MI improves long-term patency but does not improve LV ejection fraction, supporting recommendations against routine PCI in these stable patients.
Absolute Event Rate: 83% vs 25%
p-value: p=<0.001
BACKGROUND: In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function. METHODS AND RESULTS: Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy-only patients had a patent IRA (P<0.001). LV ejection fraction increased significantly (P<0.001) in both groups, with no between-group difference: PCI 4.2+/-8.9 (n=150) versus medical therapy 3.5+/-8.2 (n=136; P=0.47). Median change (interquartile range) in LV end-systolic volume index was -0.5 (-9.3 to 5.0) versus 1.0 (-5.7 to 7.3) mL/m2 (P=0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (-8.2 to 13.3) versus 5.3 (-4.6 to 23.2) mL/m2 (P=0.07) in the PCI (n=86) and medical therapy-only (n=76) groups, respectively. CONCLUSIONS: PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI.
Džavík et al. (Wed,) conducted a rct in Myocardial infarction with persistently occluded infarct-related artery (n=381). PCI with stenting vs. Optimal medical therapy alone was evaluated on IRA patency and change in LV ejection fraction (p=<0.001). PCI with stenting of a persistently occluded infarct-related artery 3-28 days post-MI improved 1-year patency (83% vs 25%, P<0.001) but did not improve LV ejection fraction (P=0.47).