title: Percutaneous coronary intervention in the Occluded Artery Trial: procedural success, hazard, and outcomes over 5 years.
abstract: 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.
authors.affiliation: Vancouver General Hospital, Vancouver, British Columbia, Canada. cbuller@interchange.ubc.ca
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: Boban
authors.initials: B
authors.lastname: Thomas
authors.forename: Sandra
authors.initials: S
authors.lastname: Forman
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: Lampros K
authors.initials: LK
authors.lastname: Michalis
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Abreu
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: 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
chemical_list: D002317:Cardiovascular Agents
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