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(Circulation. 2009;119:779-787.)
© 2009 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Electrophysiological Effects of Late Percutaneous Coronary Intervention for Infarct-Related Coronary Artery Occlusion

The Occluded Artery Trial-Electrophysiological Mechanisms (OAT-EP)

Eric J. Rashba, MD; Gervasio A. Lamas, MD; Jean-Philippe Couderc, PhD; Sharri M. Hollist, MPH; Vladimir Dzavik, MD; Witold Ruzyllo, MD; Viliam Fridrich, MD; Christopher E. Buller, MD; Sandra A. Forman, MA; Joseph A. Kufera, MA; Antonio C. Carvalho, MD; Judith S. Hochman, MD, for the OAT-EP Investigators

From the Stony Brook University Medical Center, Stony Brook, NY (E.R.); Mount Sinai Medical Center, Miami Beach, Fla (G.A.L.); University of Rochester Medical Center, Rochester, NY (J.P.C.); University of Maryland Medical Center, Baltimore (S.H.); University Health Network, Toronto General Hospital, Toronto, Ontario, Canada (V.D.); National Institute of Cardiology, Warsaw, Poland (W.R.); Slovak Institute of Cardiovascular Diseases, Bratislava, Slovakia (V.F.); Vancouver General Hospital, Vancouver, BC, Canada (C.E.B.); Maryland Medical Research Institute, Baltimore (S.F.); Kufera Consulting, Inc, Monkton, Md (J.A.K.); Federal University of Saõ Paolo, Saõ Paolo, Brazil (A.C.C.); and New York University School of Medicine, New York (J.S.H.).

Correspondence to Eric J. Rashba, MD, Professor of Medicine, Director, Electrophysiology Laboratories, Stony Brook University School of Medicine, Health Sciences Center T16-080, 100 Nicolls Rd, Stony Brook, NY 11794. E-mail eric.rashba{at}stonybrook.edu

Received July 20, 2008; accepted November 7, 2008.

Background— The Occluded Artery Trial-Electrophysiological Mechanisms (OAT-EP) tested the hypothesis that opening a persistently occluded infarct-related artery by percutaneous coronary intervention and stenting (PCI) after the acute phase of myocardial infarction compared with optimal medical therapy alone reduces markers of vulnerability to ventricular arrhythmias.

Methods and Results— Between April 2003 and December 2005, 300 patients with an occluded native infarct-related artery 3 to 28 days (median, 12 days) after myocardial infarction were randomized to PCI or optimal medical therapy. Ten-minute digital Holter recordings were obtained before randomization, at 30 days, and at 1 year. The primary end point was the change in 1, a nonlinear heart rate variability parameter, between baseline and 1 year. Major secondary end points were the changes in the filtered QRS duration on the signal-averaged ECG and variability in T-wave morphology (T-wave variability) between baseline and 1 year. There were no significant differences in the changes in 1 (–0.04; 95% CI, –0.12 to 0.04), filtered QRS (2.2 ms; 95% CI, –1.4 to 5.9 ms), or T-wave variability (3.0 µV; 95% CI, –4.8 to 10.7 µV) between the PCI and medical therapy groups (medical therapy change minus PCI change). Multivariable analysis revealed that the results were unchanged after adjustment for baseline clinical variables and medication treatments during the Holter recordings.

Conclusions— PCI with stenting of a persistently occluded infarct-related artery during the subacute phase after myocardial infarction compared with medical therapy alone had no significant effect on changes in heart rate variability, the time-domain signal-averaged ECG, or T-wave variability during the first year after myocardial infarction. These findings are consistent with the lack of clinical benefit, including no reduction in sudden death, with PCI for stable patients with persistently occluded infarct-related arteries after myocardial infarction in the main OAT.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 119: 765-767. [Extract] [Full Text]