Abstract 2813: Causes of Death in Early MI Survivors With Persistent Vessel Occlusion: Results from the Occluded Artery Trial (OAT)
Background. OAT randomized patients with a persistently occluded infarct artery up to 28 days post MI. The study demonstrated that PCI did not reduce the occurrence of the primary composite end point of death, re-MI, and New York Heart Association class IV heart failure (HF4). Rate of death was not different between treatment groups after mean follow up of 3.2 years. In view of prior literature in similar cohorts showing fewer sudden cardiac deaths (SCD) with PCI, and the observed trends toward excess re-MI (OAT) but less LV remodeling (TOSCA-2) with PCI, causes of death were analyzed in more detail.
Methods. Analysis was based on 174 deaths with available cause of death information, of the 184 deaths in 2201 (2166 ± 35 substudy) patients. Of those, 42 patients had reached a component of the primary end point prior to death (24 patients with HF, 11 patients with MI, and 7 patients with both HF and MI). Stepwise Cox regression was used to examine baseline variables associated with specific causes of death. Significance was set at p<0.01 (2° analyses).
Results. The immediate cause of death, and disease or injury initiating the train of events leading directly or indirectly to death (primary cause of death) are listed in the table⇓ for 1101 PCI vs. 1100 MED patients. There were no differences in the distribution of causes of death by treatment group. PCI-related death occurred in 4 PCI group patients and 2 MED patients undergoing PCI. Baseline variables associated with cardiovascular vs. non-cardiovascular death were lower ejection fraction (p<0.01) and higher glomerular filtration rate (p<0.005). Variables associated with SCD vs. non-sudden death were lower ejection fraction (p=0.001) and younger age (p=0.001).
Conclusions. In stable post-MI patients with occlusion of the infarct-related artery, PCI did not change the overall rate or cause of death.