Abstract 16299: Long-Term Follow Up of the Viability Guided Angioplasty after Acute Myocardial Infarction (VIAMI) Trial
Background: Patients with ST-elevation myocardial infarction (STEMI) not treated with primary or rescue percutaneous coronary intervention (PCI) are at risk for recurrent ischemia. The AHA/ACC and ESC guidelines recommend an early pharmacoinvasive strategy after thrombolysis in high risk patients (<24 hours). In non-high risk patients angiography should be considered before discharge. In these patients, with proven viability in the infarct-area, the VIAMI trial showed benefit of early in-hospital stenting of the infarct-related coronary artery for the composite of death, recurrent MI, or unstable angina at 1 year follow-up. The study also revealed a low risk of recurrent ischemia in patients without viability.
Methods: After being stable during the first 48 hours of their acute MI, we randomly assigned 216 patients with viability to an invasive or a conservative (ischemia-guided) strategy. In the invasive strategy stenting of the infarct-related coronary artery was intended with abciximab as adjunct treatment. Seventy-five (75) patients without viability served as registry group. The outcomes were the composite of death from any cause, recurrent MI and unstable angina. The need for (repeat) revascularization procedures was also recorded.
Results: After a mean follow up of 8 years, the combined endpoint of death, recurrent MI and unstable angina was 21.8% in the invasive group and 34.3% in the conservative group (Hazard ratio 0.56; 95% CI 0.35-0.99, p=0.044). No differences were seen in death (8.9% vs. 8.6%, p=0.93) or myocardial infarction (7.9% vs. 11.4%, p=0.40). Only unstable angina showed a significant difference (5.0% vs. 14.3%, p=0.02). Repeated revascularization was performed in 22.8% of the invasive group and 44.8% of the conservative group (Hazard ratio 0.43; 95% CI 0.27-0.68, p<0.001). Compared to the conservative group, the non-randomized non-viable group showed a trend to an increased mortality (16.9% vs. 8.6%, p=0.09) with equal recurrent ischemic events.
Conclusion: In patients with acute MI (treated with thrombolysis or without reperfusion therapy) and proven viability in the infarct-area, we demonstrated a long-term benefit of early in-hospital stenting of the infarct-related coronary artery.
- © 2012 by American Heart Association, Inc.