The occluded coronary artery in the asymptomatic patient after myocardical infarction: should it be opened?
This article reviews the evidence surrounding the "open artery theory": that the opening of an occluded artery in an asymptomatic patient after myocardial infarction confers survival benefits in excess of the amount of myocardium salvaged. Several mechanisms have been proposed in support of the theory, all of which remain unproven. The bulk of current knowledge about the open artery is drawn from observations on the spontaneous state of patency of the infarct-related artery and the results of ischaemia-driven intervention. The various studies indicate that the advantage of a patent infarct-related artery is confined to groups of patients with left ventricular dysfunction or extensive (and particularly anterior) infarctions. The largest database that examined the effect of the open artery did not find an independent association with survival a year after the infarct. The frequency of a totally occluded artery post-infarction, the lower rate of success in recanalising the vessel, and the high rate of reocclusion mediates against a policy of routinely opening the occluded vessel. The Occluded Artery Trail is comparing the outcomes in post-infarction patients with proximally occluded vessels that supply substantial amounts of myocardium randomised to either percutaneous recanalisation or medical therapy.
Milpark Hospital, Parktown West, Johannesburg 2193, South Africa.
Anthony John
AJ
Dalby
D015906:Angioplasty, Balloon, Coronary / Q000592:standards; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left