Abstract 2812: Predictors of Reinfarction Following PCI or Medical Management in Patients With Persistent Total Occlusion After Myocardial Infarction: Results from the Occluded Artery Trial (OAT)

Abstract

Background : The Occluded Artery Trial (OAT) randomized 2201 patients (up to 28 days post MI) with an occluded infarct-related artery to either percutaneous coronary intervention (PCI) or medical treatment alone (MED). There was no difference in five-year life table event rates for the primary end point of death, reinfarction (ReMI) or heart failure. However in patients randomized to PCI there was a trend for an increase in adjudicated ReMI: 7.0% vs. 5.1%, HR 1.35 (95% CI: 0.92–1.99, p=0.12) and investigator-reported ReMI: 10.9% PCI vs 7.9% MED, HR 1.36, (95% CI: 0.98 –1.86, p=0.05). Aim : To determine independent predictors of ReMI. Methods : ReMIs were adjudicated and required two of the following: ischemic symptoms ≥30 min, ECG changes and marker elevation [creatinine kinase elevation 2x upper limit of normal (ULN), CKMB >ULN or troponin 2x ULN; after PCI, CK or CK-MB 3x ULN and after surgery, CK or CK-MB 5x ULN]. Cox multivariable regression models were developed including baseline demographics, angiographic data, and discharge medications. P<0.01 was considered significant for this secondary analysis. Results: Conclusions : In the OAT trial predictors of adjudicated ReMI were prior MI (before qualifying MI) and diabetes. The predictors were similar for both treatment groups and no single angiographic factor or effect of medication was identified. Adjudicated ReMI