title: Comparison of late results of percutaneous coronary intervention among stable patients ≤65 versus >65 years of age with an occluded infarct related artery (from the Occluded Artery Trial).
abstract: Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. The primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged ≤65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). The 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). The rate of early PCI complications was low in the 2 age groups. The trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. In conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age.
authors.affiliation: Leon H. Charney Division of Cardiology, NYU Medical Center, New York, USA. adam.skolnick@nyumc.org
authors.forename: Adam H
authors.initials: AH
authors.lastname: Skolnick
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Camille A
authors.initials: CA
authors.lastname: Pearte
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.forename: Rudyney E U
authors.initials: RE
authors.lastname: Azevedo
authors.forename: Erwin
authors.initials: E
authors.lastname: Schroeder
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
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult