DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction.
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.
Steg
Philippe Gabriel
PG
Department of Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. gabriel.steg@bch.ap-hop-paris.fr
Thuaire
Christophe
C
Himbert
Dominique
D
Carrié
Didier
D
Champagne
Stéphane
S
Coisne
Damien
D
Khalifé
Khalife
K
Cazaux
Pierre
P
Logeart
Damien
D
Slama
Michel
M
Spaulding
Christian
C
Cohen
Ariel
A
Tirouvanziam
Ashok
A
Montély
Jean-Michel
JM
Rodriguez
Rosa-Maria
RM
Garbarz
Eric
E
Wijns
William
W
Durand-Zaleski
Isabelle
I
Porcher
Raphaël
R
Brucker
Lionel
L
Chevret
Sylvie
S
Chastang
Claude
C
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