title: Loss of short-term symptomatic benefit in patients with an occluded infarct artery is unrelated to non-protocol revascularization: results from the Occluded Artery Trial (OAT).
abstract: BACKGROUND
  the OAT found that routine late (3-28 days post-myocardial infarction) percutaneous coronary intervention (PCI) of an occluded infarct-related artery did not reduce death, reinfarction, or heart failure relative to medical treatment (MED). Angina rates were lower in PCI early, but the advantage over MED was lost by 3 years.
  
  
  METHODS
  angina and revascularization status were collected at 4 months, then annually. We assessed whether non-protocol revascularization procedures in MED accounted for loss of the early symptomatic advantage of PCI.
  
  
  RESULTS
  seven per 100 more PCI patients were angina-free at 4 months (P < .001) and 5 per 100 at 12 months (P = .005) with the difference narrowing to 1 per 100 at 3 years (P = .34). Non-protocol revascularization was more frequent in MED (5-year rate 22% vs 19% PCI, P = .05). Indications for revascularization included acute coronary syndromes (39% PCI vs 38% MED), stable angina/inducible ischemia (39% in each group), and physician preference (17% PCI vs 15% MED). Revascularization rates among patients with angina at any time during follow-up (35% of cohort) did not differ by treatment group (5-year rates 26% PCI vs 28% MED). Most symptomatic patients were treated without revascularization during follow-up (77%).
  
  
  CONCLUSIONS
  in a large randomized clinical trial of stable post-myocardial infarction patients, the modest benefit on angina from PCI of an occluded infarct-related artery was lost by 3 years. Revascularization was slightly more common in MED during follow-up but was not driven by acute ischemia, and almost 1 in 5 procedures were attributed to physician preference alone.
authors.affiliation: Waikato Hospital, Hamilton, New Zealand.
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: James M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Carlos
authors.initials: C
authors.lastname: Vozzi
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Paulo
authors.initials: P
authors.lastname: Caramori
authors.forename: Vladimir
authors.initials: V
authors.lastname: Džavík
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Forman
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome