Coronary Intervention for Persistent Occlusion after Myocardial Infarction

Hochman, Judith S.; Lamas, Gervasio A.; Buller, Christopher E.; Džavík, Vladimir; Reynolds, Harmony R.; Abramsky, Staci; Forman, Sandra; Rużyłło, Witold; Maggioni, Aldo P.; White, Harvey D.; Sadowski, Zygmunt; Carvalho, Antônio Carlos; Rankin, Jamie; Renkin, Jean; Steg, Philippe Gabriel; Mascette, Alice M.; Sopko, George; Pfisterer, Matthias; Leor, Jonathan; Fridrich, Viliam; Mark, Daniel B.; Knatterud, Genell L.

doi:10.1056/nejmoa066139

Cited by 646 publications

(452 citation statements)

References 39 publications

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“…Patients without ongoing chest pain or inducible ischaemia, presenting between 3 and 28 days with persistent coronary artery occlusion, did not benefit from PCI [90,91]. Thus, in patients presenting days after the acute event with a fully developed Q-wave MI, only patients with recurrent angina and/or documented residual ischaemia and proven viability in a large myocardial territory are candidates for mechanical revascularization.…”

Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

“…Following the negative results of two RCTs addressing the usefulness of opening occluded culprit coronary arteries in the early post-MI phase [90,91,211], there is some confusion regarding the indications for PCI in 'chronic' total occlusions. In asymptomatic patients within 3 28 days after MI, the OAT trial showed no survival advantage from PCI and less recurrent MI with the conservative approach [90,211]. The results of OAT do not necessarily pertain to CTOs.…”

Section: Specific Lesion Subsetsmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

Section: Specific Lesion Subsetsmentioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

View full text Add to dashboard Cite

“…Studies have shown that PCI elective prescription for an occluded coronary artery within one to 28 days after the AMI occurrence in stable patients, did not provide any benefit greater than that offered by medical therapy consisting of aspirin, betablockers, angiotensin converting enzyme inhibitors and statins in preserving left ventricular contractile function and new cardiovascular events 22,23 . The population served in HSPE-FMO, IAMSPE is characterized by the prevalence of elderly patients and patients over 70 years old account for approximately 30.0% of the admissions information of great importance since such patients are often excluded from clinical trials 34 .…”

Section: Galon Et Al Coronary Artery Disease In the Elderlymentioning

confidence: 99%

Perfil clínico-angiográfico na doença arterial coronariana: desfecho hospitalar com ênfase nos muito idosos

Galon

Meireles

Kreimer

et al. 2010

Arq. Bras. Cardiol.

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“…2 This was a National Heart, Lung, and Blood Institute-supported trial. This trial was similar to the DECOPI trial, but more patients were enrolled, such as 1,082 randomized to PCI/stent plus medical therapy and 1,084 randomized to medical therapy.…”

Section: The Occluded Artery Trialmentioning

confidence: 99%

Some Patients with Persistent Coronary Artery Occlusion after Acute Myocardial Infarction may Require Revascularization

Conti¹

2007

Clinical Cardiology

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eagues. 1 This trial was designed to evaluate the efficacy of percutaneous coronary interventions (PCI) compared with medical therapy in patients with an occluded coronary artery 2-15 days after myocardial infarction. Of the 212 patients, 109 were randomized to PCI and 103 were randomized to medical therapy. The medical therapy and PCI used were state-of-the-art. The mean time to PCI was 8 days. A large percentage of patients had single-vessel disease. Results indicated there was no difference in the primary combined endpoint of cardiac death MI or ventricular tachyarrhythmias between the two treatment arms. At 6 months, angiographic patency was more frequent in the PCI arm and left ventricular ejection fraction was greater. The trial was likely underpowered for the primary endpoint analysis and cases were at relatively low risk since exclusions from the trial were left main coronary stenosis, need for CABG, and PCI not technically feasible. The Occluded Artery TrialAt the 2006 American Heart Association meeting in Chicago, Judith Hochman presented the Occluded Artery Trial (OAT). 2 This was a National Heart, Lung, and Blood Institute-supported trial. This trial was similar to the DECOPI trial, but more patients were enrolled, such as 1,082 randomized to PCI/stent plus medical therapy and 1,084 randomized to medical therapy. Patients were stable but had persistent occlusion of the infarct-related artery, 3-28 days following myocardial infarction. Most (82%) had single-vessel disease, 49% involving the right coronary artery. Primary endpoint was death, MI, or severe heart failure, and the mean follow-up was 3 years. It must be emphasized that these patients were stable myocardial infarction survivors who did not receive PCI within the first 12 h of their infarction. It must also be emphasized that the patients who received PCI/stent also received optimal medical therapy as did all patients randomized to medical therapy. Exclusions from this trial included patients with high grade left main coronary artery stenosis or high grade three-vessel disease, angina at rest, severe ischemia on stress testing, hemodynamic or electrical instability, serum creatinine greater than 2.5 mg/dL, class III or IV heart failure, or shock. As in the DECOPI trial, median time from myocardial infarction to randomization was 8 days. In this group of selected randomized patients, results showed there was no difference in the primary composite endpoint of death, reinfarction, or severe heart failure. Initial success was seen in 87% of the PCI group and 89% were still open at 1 year. In the patients randomized to medical therapy, ninety patients crossed over to revascularization, suggesting that recurrent symptoms were present. There was a trend toward more reinfarction in the PCI group than in the medical group. This may be related to the fact that patients who received PCI had more patent arteries that might reocclude compared to the smaller percentage of patent arteries in patients randomized to medical therapy. No information is availa...

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Coronary Intervention for Persistent Occlusion after Myocardial Infarction

Cited by 646 publications

References 39 publications

Guidelines on myocardial revascularization

Guidelines on myocardial revascularization

Perfil clínico-angiográfico na doença arterial coronariana: desfecho hospitalar com ênfase nos muito idosos

Some Patients with Persistent Coronary Artery Occlusion after Acute Myocardial Infarction may Require Revascularization

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