title: Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: a pooled analysis of cardiovascular magnetic resonance studies.
abstract: BACKGROUND
  The results of clinical trials assessing the effect of late opening of infarct-related artery (IRA) on left ventricular ejection fraction (LVEF) and size in stable patients are equivocal, which may be related to the fact that the presence of viability was not a requirement for randomization in these trials. The aim of the study was to assess the influence of late percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) vs. OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance (CMR).
  
  
  METHODS
  The analysis included pooled data of 43 patients from 3 randomized studies. All patients underwent CMR before randomization, but only in 1 previously unpublished study was preserved viability required for randomization to treatment. Follow-up CMR was performed after 6-12 months.
  
  
  RESULTS
  Late PCI with OMT led to improved LVEF (+5 ± 7% vs. -1 ± 6%, p = 0.005), decreased left ventricular end-systolic volume (-11 ± 19 mL vs. 12 ± 40 mL, p = 0.02) and a trend towards a decrease in end-diastolic volume (-7 ± 27 mL vs. 15 ± 47 mL, p = 0.07) in comparison to OMT alone. Increased LVEF and decreased left ventricular volumes were observed after the analysis was restricted to patients with left anterior descending artery (LAD) occlusion.
  
  
  CONCLUSIONS
  In patients with the presence of infarct zone viability, OMT with late PCI for an occluded IRA (particularly LAD) is associated with improvement of left ventricular systolic function and size over OMT alone.
authors.affiliation: Department of Inter ventional Cardiology and Angiology, Institute of Car diology, Warsaw, Poland. lmalek@ikard.pl.
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Małek
authors.forename: Joao C
authors.initials: JC
authors.lastname: Silva
authors.forename: Nick G
authors.initials: NG
authors.lastname: Bellenger
authors.forename: Jose C
authors.initials: JC
authors.lastname: Nicolau
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kłopotowski
authors.forename: Mateusz
authors.initials: M
authors.lastname: Spiewak
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Rassi
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Lewandowski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D054059:Coronary Occlusion / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling