Causes of death in early MI survivors with persistent infarct artery occlusion: results from the Occluded Artery Trial (OAT).
OBJECTIVE
OAT randomised patients with an occluded infarct artery three to 28 days after myocardial infarction (MI). The study demonstrated that PCI did not reduce the occurrence of the primary composite endpoint of death, re-MI, and New York Heart Association class IV heart failure in comparison with patients assigned to optimal medical therapy alone (MED). In view of prior literature in similar cohorts showing fewer sudden cardiac deaths and less left ventricular (LV) remodelling, but excess re-MI with PCI, causes of death were analysed in more detail.


RESULTS
Stepwise Cox regression was used to examine baseline variables associated with causes of death. The immediate and primary cause of death did not differ between 1,101 PCI and 1,100 MED patients. One-year cardiovascular death rates were 3.8% for the PCI group, and 3.7% for the MED group, and 0.9% per year for the next four years in both groups. Five of six cases of cardiac rupture occurred in patients undergoing PCI.


CONCLUSIONS
In stable post-MI patients with occlusion of the infarct-related artery, PCI did not change the rate or cause of death. The observation that the majority of cardiac ruptures occurred in patients undergoing PCI deserves further investigation.
Lang
Irene M
IM
Medical University of Vienna, Vienna, Austria. irene.lang@meduniwien.ac.at
Forman
Sandra A
SA
Maggioni
Aldo P
AP
Ruzyllo
Witold
W
Renkin
Jean
J
Vozzi
Carlos
C
Steg
P Gabriel
PG
Hernandez-Garcia
Jose-Maria
JM
Zmudka
Krzysztof
K
Jimenez-Navarro
Manuel
M
Sopko
George
G
Lamas
Gervasio A
GA
Hochman
Judith S
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006342:Heart Rupture, Post-Infarction / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome