Late PCI with optimal medical therapy improved left ventricular ejection fraction (+5% vs -1%, p=0.005
Meta-Analysis (n=43)
Randomized
Yes
Does late PCI with OMT improve cardiac function and remodeling in stable patients with an occluded infarct-related artery and preserved infarct zone viability compared to OMT alone?
Late PCI of an occluded infarct-related artery improves LVEF and reduces LV volumes in patients with preserved infarct zone viability, suggesting viability testing may identify patients who benefit from late revascularization.
Absolute Event Rate: 5% vs -1%
p-value: p=0.005
BACKGROUND: The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR). METHODS: The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6-12 months. RESULTS: Late PCI with OMT led to improved LVEF (+5 ± 7% vs. -1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (-11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (-7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion. CONCLUSIONS: In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone.
Małek et al. (Thu,) conducted a meta-analysis in Myocardial infarction with occluded infarct-related artery and preserved infarct zone viability (n=43). Late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on Change in left ventricular ejection fraction (LVEF) (p=0.005). Late PCI with optimal medical therapy improved left ventricular ejection fraction (+5% vs -1%, p=0.005.