OAT
Trial question
What is the role of PCI in stable patients with occlusion of the infarct-related artery 3-28 days after MI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
22.0% female
78.0% male
N = 2166
2166 patients (476 female, 1690 male).
Inclusion criteria: stable patients who had total occlusion of the infarct-related artery 3 to 28 days after MI and who met a high-risk criterion (an ejection fraction of < 50% or proximal occlusion).
Key exclusion criteria: NYHA class III or IV HF, shock, a serum creatinine concentration > 2.5 mg/dL, angiographically significant left main or three-vessel coronary artery disease, angina at rest, and severe ischemia on stress testing.
Interventions
N=1082 PCI (stent and optimal medical therapy).
N=1084 medical therapy (conventional medical therapy alone).
Primary outcome
Death, MI, or NYHA class IV heart failure at 4 years
17.2%
15.6%
17.2 %
12.9 %
8.6 %
4.3 %
0.0 %
Percutaneous coronary
intervention
Medical
therapy
No significant
difference ↔
No significant difference in death, MI, or NYHA class IV HF at 4 years (17.2% vs. 15.6%; HR 1.16, 95% CI 0.92 to 1.45).
Secondary outcomes
No significant difference in MI, both fatal and nonfatal (7% vs. 5.3%; HR 1.36, 95% CI 0.92 to 2).
No significant difference in nonfatal reinfarction (6.9% vs. 5%; HR 1.44, 95% CI 0.96 to 2.16).
Conclusion
In stable patients who had total occlusion of the infarct-related artery 3 to 28 days after MI and who met a high-risk criterion (an ejection fraction of < 50% or proximal occlusion), PCI was not superior to medical therapy with respect to death, myocardial infarction, or NYHA class IV HF at 4 years.
Reference
Hochman JS, Lamas GA, Buller CE et al. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006 Dec 7;355(23):2395-407.
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