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November 22, 2006
By
Sahar
Bedrood B.S. and Asher Kimchi M.D.
New York, NY
- Current treatment of acute myocardial infarction
(MI) with ST-segment elevation includes early
reperfusion with primary percutaneous coronary
intervention (PCI). For patients with persistent
total occlusion of the infarct-related artery who
have been identified after the currently accepted
period during which reperfusion is administered, the
best strategy for care has been unclear until now.
Judith Hochman M.D., et al from the New York
University School of Medicine, conducted a 4 year
study showing that PCI did not reduce the occurrence
of death, reinfarction or heart failure in patients
with occlusion of the infarct-related artery 3 to 28
days after myocardial infarction. The article was
published in the November 14, 2006 issue of The New
England Journal of Medicine.
A randomized
study involving 2166 stable patients who had total occlusion of
the infarct-related artery 3 to 28 days after myocardial
infarction and who met a high risk criterion was done. Of these
patients, 1082 were assigned to routine PCI and stenting with
optimal medical therapy and 1084 were assigned to optimal
medical therapy alone.
The 4 year
cumulative primary event rate was 17.2% in the PCI group and
15.6% in the medical therapy group (hazard ratio, 1.16; 95% CI,
0.92 to 1.45, P=0.20). Rates of myocardial reinfarction were
7.0% and 5.3 % in the two groups, respectively. (Hazard ratio,
1.36; 95% CI, 0.92 to 2.0, P= 0.13). Rates of nonfatal
reinfarction were 6.9% and 5.0%, respectively (hazard ratio,
1.44; 95% CI, 0.96 to 2.16; P=0.08); only six reinfarctions
(0.6%) were related to assigned PCI procedures. Rates of New
York Heart Association class IV heart failure were 4.4% vs.
4.5%, respectively. Rates of death were 9.1% vs. 9.4%
respectively.
The study
concluded that PCI did not reduce the occurrence of death,
reinfarction, or heart failure and there was a trend toward
excess reinfarction during 4 years of follow-up in stable
patients with occlusion of the infarct-related artery 3 to 28
days after myocardial infarction.
Co-authors: Judith S. Hochman, M.D., Gervasio A. Lamas, M.D.,
Christopher E. Buller, M.D., Vladimir Dzavik, M.D., Harmony R.
Reynolds, M.D., Staci J. Abramsky, M.P.H., Sandra Forman, M.A.,
Witold Ruzyllo, M.D., Aldo P. Maggioni, M.D., Harvey White,
M.D., Zygmunt Sadowski, M.D., Antonio C. Carvalho, M.D., Jamie
M. Rankin, M.D., Jean P. Renkin, M.D., P. Gabriel Steg, M.D.,
Alice M. Mascette, M.D., George Sopko, M.D., Matthias E.
Pfisterer, M.D., Jonathan Leor, M.D., Viliam Fridrich, M.D.,
Daniel B. Mark, M.D., M.P.H., Genell L. Knatterud, Ph.D., for
the Occluded Artery Trial Investigators
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