Clinical InvestigationAcute Ischemic Heart DiseaseReinfarction after percutaneous coronary intervention or medical management using the universal definition in patients with total occlusion after myocardial infarction: Results from long-term follow-up of the Occluded Artery Trial (OAT) cohort
Section snippets
Patient population
The design of the OAT study has been described in detail.3, 5 In summary, between February 2000 and June 2006, 2,201 patients were enrolled. Eligible patients had a totally occluded IRA on angiography on calendar days 3 to 28 (>24 hours) after MI, met an additional high-risk criterion (ejection fraction <50% or proximal occlusion), and were clinically stable. Exclusion criteria included NYHA class III or IV heart failure, shock, serum creatinine >2.5 mg/dL (221 μmol/L), significant left main or
Results
Review of all suspected reinfarctions submitted by sites resulted in an additional 29 events according to the universal definition that were not confirmed by the Mortality and Morbidity Classification Committee (MMCC) because they did not meet the OAT criteria defined in the original protocol (Figure 1; Table I). Of these 29 events, 9 were classified as spontaneous MI, 4 as secondary, 10 as sudden death, 4 as PCI related, 1 as stent related, and 1 as CABG related.
There were 169 reinfarctions
Discussion
In this trial of 2,201 stable patients with occluded IRAs treated medically or with PCI in the subacute-phase post-MI, we found a low rate of reinfarction that continued to accrue over 9 years of follow-up. The low rates of reinfarction illustrate the stable ischemic substrate of these patients when treated with the current medical therapy. There was a trend for more reinfarctions in patients randomized to PCI (P = .08). The reinfarctions in the PCI group were similar to those in the MED group
Conclusions
In the OAT trial, there was an ongoing low rate of reinfarction at 9 years of follow-up. Reinfarction tended to occur at a higher rate in patients randomized to PCI. Most reinfarctions were spontaneous (type 1), which occurred at a similar frequency in both randomized treatment groups. However, in the PCI group, there were more type 4a (both protocol PCI-related and other PCI-related reinfarctions) and type 4b (stent thrombosis) reinfarctions. The reinfarctions were clinically significant, with
Disclosures
Conflict of interest statement: Drs White, Reynolds, Carvalho, Liu, Martin, Pearte, Knatterud, Kruk, Cantor, Menon, and Hochman report having no conflict of interest. Dr Dzavik received consulting fees from Cordis (a Johnson & Johnson company) and Boston Scientific, speaking fees, and grant support from Cordis and Abbott Vascular. Dr Steg received consulting and speaking fees from Merck and honoraria from Schering-Plough. Dr Lamas received speaking fees from Medtronic and Guidant and consulting
Acknowledgements
We would like to thank the patients in the OAT trial, the investigators, and coordinators who enrolled and followed up the patients, Charlene Nell for secretarial assistance, and Sharon Fick for coordinating the review committee.
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