Abstract 2811: Predictors of Outcome and the Lack of Effect of PCI Across the Risk Strata in Patients With Persistent Total Occlusion After Myocardial Infarction: Results from the Occluded Artery Trial (OAT)
Aim: To determine predictors of cardiac events following MI with persistent total occlusion of the infarct-related artery (IRA) and to assess the effect of PCI in different risk categories in OAT.
Methods: Of 2201 stable patients (2166 ± 35 substudy patients, mean age 58.6 +/- 11.0) with total IRA occlusion identified up to 28 days after MI enrolled in OAT, 1101 were assigned to PCI and 1100 to medical therapy alone, and followed for a mean of 3.2 years. The primary end point was a composite of death, reinfarction or NYHA class IV heart failure (HF). Multivariable Cox regression models were developed with inclusion of demographic, clinical, and angiographic data, and discharge medications. Tertiles of predicted survival were calculated from a Cox model using the independent variables.
Results: The combined 5-year life table rate for the primary endpoint was 17.5%, including death 11.7%. Primary end point independent predictors were: history of HF (HR 2.02, p=0.001), peripheral vascular disease (HR 1.92, p=0.002), diabetes (HR 1.55, p=0.001), digoxin use (HR 2.04, p=0.001); and decreasing: EF (HR 1.04 per 1%, p<0.001), time elapsed from MI (HR 1.04 per day, p<0.001), and glomerular filtration rate (GFR) (HR 1.01 per 1mL/min, p<0.001). Independent predictors of death were: history of cerebrovascular disease (HR 2.27, p=0.002), angina (HR 1.63, p=0.003), HF (HR 2.25, p=0.002), discharge insulin use (HR 1.85, p=0.006), and decreasing: EF (HR 1.05 per 1%, p<0.001), days from MI (HR 1.03, p=0.009), and GFR (HR 1.02 per 1mL/min, p<0.001). No benefit of PCI (interaction p value = 0.83) was noted across the risk spectrum.
Conclusions: Contrary to previous revascularization experience, OAT showed no evidence of variations in PCI effect with different levels of patient risk. The occurrence of adverse events in patients with persistent total IRA occlusion post MI who are clinically stable may be predicted by routinely assessed clinical variables.