Percutaneous coronary intervention in the Occluded Artery Trial: procedural success, hazard, and outcomes over 5 years.
BACKGROUND
The Occluded Artery Trial (OAT) was a 2,201-patient randomized clinical trial comparing routine stent-based percutaneous coronary intervention (PCI) versus optimal medical therapy alone in stable myocardial infarction (MI) survivors with persistent infarct-related artery occlusion identified day 3 to 28 post MI. Intent-to-treat analysis showed no difference between strategies with respect to the incidence of new class IV congestive heart failure, MI, or death. The influence of PCI failure, procedural hazard, and crossover on trial results has not been reported.


METHODS
Study angiograms were analyzed and adjudicated centrally. Factors associated with PCI failure were examined. Time-to-event analysis using the OAT primary outcome was performed by PCI success status. Landmark analysis (up to and beyond 30 days) partitioned early hazard versus late outcome according to treatment received.


RESULTS
Percutaneous coronary intervention was adjudicated successful in >87%. Percutaneous coronary intervention failure rates were similar in US and non-US sites, and did not significantly influence outcome at 60 months (hazard ratio for success vs fail 0.79, 99% CI 0.45-1.40, P = .29). Partitioning of early procedural hazard revealed no late benefit for PCI (hazard ratio for PCI success vs medical therapy alone 1.06, 99% CI 0.75-1.50, P = .66).


CONCLUSIONS
Percutaneous coronary intervention failure and complication rates in the OAT were low. Neither PCI failure nor early procedural hazard substantively influenced the primary trial results.
Buller
Christopher E
CE
Vancouver General Hospital, Vancouver, British Columbia, Canada. cbuller@interchange.ubc.ca
Rankin
Jamie M
JM
Carere
Ronald G
RG
Buszman
Pawel E
PE
Pfisterer
Matthias E
ME
Dzavik
Vladimir
V
Thomas
Boban
B
Forman
Sandra
S
Ruzyllo
Witold
W
Mancini
G B John
GB
Michalis
Lampros K
LK
Abreu
Pedro F
PF
Lamas
Gervasio A
GA
Hochman
Judith S
JS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D002317:Cardiovascular Agents
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