title: Randomized trial of percutaneous coronary intervention for subacute infarct-related coronary artery occlusion to achieve long-term patency and improve ventricular function: the Total Occlusion Study of Canada (TOSCA)-2 trial.
abstract: BACKGROUND
  In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function.
  
  
  RESULTS
  Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy-only patients had a patent IRA (P<0.001). LV ejection fraction increased significantly (P<0.001) in both groups, with no between-group difference: PCI 4.2+/-8.9 (n=150) versus medical therapy 3.5+/-8.2 (n=136; P=0.47). Median change (interquartile range) in LV end-systolic volume index was -0.5 (-9.3 to 5.0) versus 1.0 (-5.7 to 7.3) mL/m2 (P=0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (-8.2 to 13.3) versus 5.3 (-4.6 to 23.2) mL/m2 (P=0.07) in the PCI (n=86) and medical therapy-only (n=76) groups, respectively.
  
  
  CONCLUSIONS
  PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI.
authors.affiliation: University Health Network, University of Toronto, Toronto, Ontario, Canada. vlad.dzavik@uhn.on.ca
authors.forename: Vladimír
authors.initials: V
authors.lastname: Dzavík
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: James M
authors.initials: JM
authors.lastname: Rankin
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Carere
authors.forename: John R
authors.initials: JR
authors.lastname: Ross
authors.forename: Deborah
authors.initials: D
authors.lastname: Atchison
authors.forename: Sandra
authors.initials: S
authors.lastname: Forman
authors.forename: Boban
authors.initials: B
authors.lastname: Thomas
authors.forename: Pawel
authors.initials: P
authors.lastname: Buszman
authors.forename: Carlos
authors.initials: C
authors.lastname: Vozzi
authors.forename: Anthony
authors.initials: A
authors.lastname: Glanz
authors.forename: Eric A
authors.initials: EA
authors.lastname: Cohen
authors.forename: Peter
authors.initials: P
authors.lastname: Meciar
authors.forename: Gerald
authors.initials: G
authors.lastname: Devlin
authors.forename: Alice
authors.initials: A
authors.lastname: Mascette
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Genell L
authors.initials: GL
authors.lastname: Knatterud
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002170:Canada; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*