title: Effects of timing, location and definition of reinfarction on mortality in patients with totally occluded infarct related arteries late after myocardial infarction.
abstract: BACKGROUND
  The Occluded Artery Trial (OAT) randomized stable patients (n=2201)>24 h (calendar days 3-28) after myocardial infarction (MI) with totally occluded infarct-related arteries (IRA), to percutaneous coronary intervention (PCI) with optimal medical therapy, or optimal medical therapy alone (MED). PCI had no impact on the composite of death, reinfarction, or class IV heart failure over extended follow-up of up to 9 years. We evaluated the impact of early and late reinfarction and definition of MI on subsequent mortality.
  
  
  RESULTS
  Reinfarction was adjudicated according to an adaptation of the 2007 universal definition of MI and the OAT definition (≥2 of the following--symptoms, EKG and biomarkers). Cox regression models were used to analyze the effect of post-randomization reinfarction and baseline variables on time to death. After adjustment for baseline characteristics the 169 (PCI: n=95; MED: n=74) patients who developed reinfarction by the universal definition had a 4.15-fold (95% CI 3.03-5.69, p<0.001) increased risk of death compared to patients without reinfarction. This risk was similar for both treatment groups (interaction p=0.26) and when MI was defined by the stricter OAT criteria. Reinfarctions occurring within 6 months of randomization had similar impact on mortality as reinfarctions occurring later, and the impact of reinfarction due to the same IRA and a different epicardial vessel was similar.
  
  
  CONCLUSIONS
  For stable post-MI patients with totally occluded infarct arteries, reinfarction significantly independently increased the risk of death regardless of the initial management strategy (PCI vs. MED), reinfarction definition, location and early or late occurrence.
authors.affiliation: Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.affiliation: 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, United States.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.affiliation: Hospital Sao Paulo, Moema, Sao Paulo, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.affiliation: INSERM U-698, Paris, France; Université Paris-Diderot, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Bichat-Claude Bernard, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Clinical Trial and Surveys Corp., Baltimore, United States.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: University of Verona/Instituti Ospedalieri, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, United States.
authors.forename: Camille A
authors.initials: CA
authors.lastname: Pearte
authors.affiliation: Perth Cardiovascular Institute, Perth, Australia.
authors.forename: James M
authors.initials: JM
authors.lastname: Rankin
authors.affiliation: Green Lane Cardiovascular Service, Auckland, New Zealand.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Green Lane Cardiovascular Service, Auckland, New Zealand.
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.affiliation: Cardiovascular Clinical Research Center, New York University School of Medicine, New York, United States. Electronic address: Judith.Hochman@nyumc.org.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D054059:Coronary Occlusion / Q000150:complications* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D013997:Time Factors
keywords: Late revascularization; Mortality; Myocardial infarction; Reinfarction
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