Impact of Collateral Flow to the Occluded Infarct-Related Artery on Clinical Outcomes in Patients With Recent Myocardial Infarction: A Report From the Randomized Occluded Artery Trial
Key result
Angiographic collateral flow to the occluded infarct artery was not an independent predictor of major clinical outcomes and did not interact with the effect of PCI versus medical therapy.
Why the study?
Does percutaneous coronary intervention improve clinical outcomes compared to medical therapy alone in patients with recent myocardial infarction and an occluded infarct artery, and does baseline collateral flow modify this effect?
Population
2173 patients with total occlusion of the infarct artery 3 to 28 days after recent myocardial infarction
Comparison
Percutaneous coronary intervention in addition… vs Medical therapy alone
Design
RCT, Randomized treatment assignment
Follow-up
long-term
Authors
Discussion
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Member takes
Implication
Collateral assessment should not guide late PCI decisions after MI; confirms neutral effect of recanalization independent of collaterals.
Study Design
Type
RCT (n=2,173)
Structured PICO
Does percutaneous coronary intervention improve clinical outcomes compared to medical therapy alone in patients with recent myocardial infarction and an occluded infarct artery, and does baseline collateral flow modify this effect?
P
Population
2173 patients with total occlusion of the infarct artery 3 to 28 days after recent myocardial infarction
I
Intervention
Percutaneous coronary intervention (PCI) in addition to medical therapy, stratified by baseline angiographic collateral flow
C
Comparator
Medical therapy alone
O
Outcome
Composite of death, reinfarction, or class IV heart failurecomposite
Angiographic collaterals to an occluded infarct artery after recent MI are not independent predictors of major clinical outcomes and do not modify the lack of benefit of late recanalization.
Cite This Study
Steg et al. (2010) conducted an RCT in Recent myocardial infarction (n=2,173). Percutaneous coronary intervention vs. Medical therapy alone was evaluated on Composite of death, reinfarction, or class IV heart failure. Angiographic collateral flow to the occluded infarct artery was not an independent predictor of major clinical outcomes and did not interact with the effect of PCI versus medical therapy.