title: Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT).
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) of a persistently totally occluded infarct-related artery (IRA) in stable high-risk patients >24h after myocardial infarction (MI) does not reduce the occurrence of death, re-infarction, or heart failure. Diabetic patients are at higher risk for cardiovascular events; we examined their outcomes overall with PCI and optimal medical therapy alone (MED).
  
  
  METHODS
  The long-term (7-year) outcomes of 454 diabetic patients (20.6%) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy.
  
  
  RESULTS
  The 7-year cumulative primary event rate for diabetic patients was 35.0% vs. 19.4% in the non-diabetic cohort (p<0.001). Multivariable analyses revealed diabetes to be an independent predictor (p<0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3% in the PCI group vs. 34.5% in the medical therapy group in diabetic patients (p=0.19) and 19.3% in the PCI group vs. 19.5% in the medical therapy group in patients without diabetes (p=0.60).
  
  
  CONCLUSIONS
  Despite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI.
authors.affiliation: Peter Munk Cardiac Centre, University Heath Network, Toronto, Ontario, Canada.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leor
authors.forename: Jeffery R
authors.initials: JR
authors.lastname: Burton
authors.forename: Gilmar
authors.initials: G
authors.lastname: Reis
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
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: D054059:Coronary Occlusion / Q000150:complications / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D013997:Time Factors; D016896:Treatment Outcome
keywords: Diabetes; Occluded artery; Open artery hypothesis; Percutaneous coronary intervention