Update in Cardiology

Ischemic Heart Disease

Occluded Artery Trial Investigators.

Question: Does percutaneous coronary intervention (PCI) reduce the incidence of adverse cardiovascular events in patients with myocardial infarction who present after 72 hours?

Study Design: Randomized, controlled trial.

Patients: 2166 patients who presented 3 to 28 days after an acute myocardial infarction with total occlusion of the infarct-related artery. The following were excluded: patients with New York Heart Association (NYHA) classification III or IV heart failure, shock, a serum creatinine concentration greater than 2.5 mg/dL (>221 µmol/L), angiographically significant left-main or 3-vessel coronary artery disease, angina at rest, or severe ischemia on stress testing (required if the infarct zone was not akinetic or dyskinetic).

Setting: Multicenter study conducted at sites in the United States, Canada, Latin America, Australia, New Zealand, and Europe.

Intervention: Patients were randomly assigned to PCI with stent placement and optimal medical therapy (n = 1082) or to optimal medical therapy alone (n = 1084). Optimal medical therapy comprised aspirin, anticoagulation if indicated, angiotensin-converting enzyme (ACE) inhibition, β-blockade, and lipid-lowering therapy, unless contraindicated. Thienopyridine therapy was initiated before PCI and continued for 2 to 4 weeks in patients who received stents. After reports of the efficacy of prolonged thienopyridine treatment, this therapy was recommended in the 2 study groups for 1 year after myocardial infarction.

Outcomes: The primary outcome was a composite end point of death from any cause, reinfarction, or class IV heart failure with hospitalization or admission to a short-stay unit. Secondary outcomes were the separate components of the primary end point, as well as symptoms and other clinical events.

Follow-up: Mean, 1059 days (SE, 11 days).

Sponsor: National …