Abstract 13116: Persistent Lack of Benefit of Late Revascularization of the Occluded Coronary Artery Post-MI - The Occluded Artery Trial (OAT) Long Term Results
Background: The primary report of OAT with 3.2 years follow-up showed no benefit of late opening of an occluded infarct artery compared with optimal medical therapy alone. There was a trend, however, toward more nonfatal MI's in the PCI group (p=0.08). Aim: Assess long term outcome in the OAT cohort.
Methods: OAT randomized 2201 stable, but high-risk (EF< 50% and/or proximal occlusion of a large vessel - supplying ≥ % LV) patients with persistent occlusion of the infarct related artery (IRA) 3–28 calendar days after MI (≥24 hrs) to PCI with optimal medical therapy [PCI] or medical therapy alone [MED]. Patients with severe inducible ischemia, rest angina, class III-IV heart failure (HF), 3 vessel/left main disease were excluded. Patients were followed for an additional 3 years (6 year mean survivor follow up, longest 9 years, 12,234 patient-years), increasing the number followed for ≥5 years from 163 to 1388 patients. The primary endpoint for OAT was death, reinfarction or class IV heart failure hospitalization. MIs are reported based on OAT criteria and the universal definition.
Results: The primary endpoint rate for PCI vs. MED was similar (Figure) as were the rates of nonfatal MI (HR 1.27, 95% CI 0.90 – 1.78, p=0.17), death (HR 0.98, 95% CI 0.78 −1.22, p=0.85) and class IV HF (HR 0.97, 95% CI 0.66 −1.42, p=0.87). Additional preliminary analyses: Types 1–3 (spontaneous, secondary, sudden death) MI rates were similar (HR 0.94, 95%CI 0.66 −1.34) but type 4 (PCI or stent-related) MI was more common in the PCI group [HR 3.76, 95%CI 1.87 – 7.56, p<0.001]. There was no interaction between any baseline characteristic and treatment group on outcomes, including randomization ≤72 hrs, LAD IRA or EF <50%.
Conclusions: Extended follow up of the OAT cohort provides robust data showing that routine PCI of an occluded IRA in stable pts with recent MI does not reduce clinical events. There were excess PCI/stent-related MIs in the PCI group with no suggestion of benefit for types 1–3 MI, HF, death.
- Interventional cardiology
- Percutaneous coronary intervention
- Myocardial infarction
- Clinical trials
- Coronary artery disease
- © 2010 by American Heart Association, Inc.