title: DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction.
abstract: OBJECTIVE
  To determine whether late recanalization of an occluded infarct artery after acute myocardial infarction is beneficial.
  
  
  RESULTS
  Two hundred and twelve patients with a first Q-wave myocardial infarction (MI) and an occluded infarct vessel were enrolled. After coronary and left ventricular contrast angiography, patients were randomized to percutaneous revascularization (PTCA, n=109), carried out 2-15 days after symptom onset or medical therapy (n=103). The primary endpoint was a composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia. The majority had single-vessel disease and less than one-third had involvement of the left anterior descending artery. The use of pharmacological therapy was high in both groups. At six months, left ventricular ejection fraction was 5% higher in the invasive compared with the medical group (P=0.013) and more patients had a patent artery (82.8% vs 34.2%, P<0.0001). Restenosis was seen in 49.4% of patients in the PTCA group. At a mean of 34 months of follow-up, the occurrence of the primary endpoint was similar in the medical and PTCA groups (8.7% vs 7.3% respectively, P=0.68), but the overall costs were higher for PTCA. The secondary endpoint combining the primary endpoint with admission for heart failure was also similar between groups (12.6% vs 10.1% in the medical and PTCA groups, respectively, P=0.56).
  
  
  CONCLUSIONS
  Systematic late PTCA of the infarct vessel was associated with a higher left ventricular ejection fraction at six months, no difference in clinical outcomes, and higher costs than medical therapy. These results must be interpreted with caution given the small size and low risk of the population.
authors.affiliation: Department of Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. gabriel.steg@bch.ap-hop-paris.fr
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Christophe
authors.initials: C
authors.lastname: Thuaire
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Stéphane
authors.initials: S
authors.lastname: Champagne
authors.forename: Damien
authors.initials: D
authors.lastname: Coisne
authors.forename: Khalife
authors.initials: K
authors.lastname: Khalifé
authors.forename: Pierre
authors.initials: P
authors.lastname: Cazaux
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.forename: Ashok
authors.initials: A
authors.lastname: Tirouvanziam
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Montély
authors.forename: Rosa-Maria
authors.initials: RM
authors.lastname: Rodriguez
authors.forename: Eric
authors.initials: E
authors.lastname: Garbarz
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Lionel
authors.initials: L
authors.lastname: Brucker
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Claude
authors.initials: C
authors.lastname: Chastang
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods*; D023921:Coronary Stenosis / Q000191:economics / Q000628:therapy*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D019233:Retreatment; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency