title: Long-term follow-up of the viability guided angioplasty after acute myocardial infarction (VIAMI) trial.
abstract: BACKGROUND
  Patients with ST-elevation myocardial infarction (STEMI) not treated with primary or rescue percutaneous coronary intervention (PCI) are at risk for recurrent ischemia. In non-high risk patients, with proven viability in the infarct-area, the VIAMI trial showed benefit of early in-hospital stenting of the infarct-related coronary artery for the composite of death, myocardial infarction (MI), or unstable angina (UA) at 1 year follow-up. In this study we evaluated the long-term outcome (median 8 years) of patients included in the VIAMI-trial.
  
  
  METHODS
  After being stable during the first 48 h of their acute MI, we randomly assigned 216 patients with viability to an invasive (PCI) or a conservative (ischemia-guided) strategy. The primary outcome was the composite endpoint of death from any cause, recurrent myocardial infarction, or unstable angina. The secondary outcome of this study was the need for (repeat) revascularization.
  
  
  RESULTS
  The combined endpoint of death, recurrent MI and UA was 20.8% in the invasive group and 32.7% in the conservative group (hazard ratio 0.59; 95% CI 0.36-0.99, p = 0.049). No differences were seen in death (8.5% vs. 8.2%, p = 0.80) or MI (7.5% vs. 10.9%, p = 0.48). Only UA showed a significant difference (4.7% vs. 13.6%, p = 0.002). Repeated revascularization was performed in 22.6% of the invasive group and 41.8% of the conservative group (hazard ratio 0.43; 95% CI 0.29-0.74, p < 0.001).`
  
  
  CONCLUSIONS
  In patients with acute MI (treated with thrombolysis or without reperfusion therapy) and proven viability in the infarct-area, we demonstrated a long-term benefit of early in-hospital stenting of the infarct-related coronary artery.
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: rb.vanloon@vumc.nl.
authors: Ramon B
authors: RB
authors: van Loon
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Gerrit
authors: G
authors: Veen
authors: Atrium Medical Center Parkstad, Heerlen and Faculty of Health, Medicine and Life Sciences, University Maastricht, The Netherlands.
authors: Leo H B
authors: LH
authors: Baur
authors: Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors: Jos W R
authors: JW
authors: Twisk
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Albert C
authors: AC
authors: van Rossum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009204:Myocardial Revascularization; D011446:Prospective Studies; D015607:Stents; D055815:Young Adult
keywords: Myocardial infarction; Percutaneous coronary intervention; Prognosis; Viability