Long-term effects of percutaneous coronary intervention of the totally occluded infarct-related artery in the subacute phase after myocardial infarction.
Long-term effects of percutaneous coronary intervention of the totally occluded infarct-related artery in the subacute phase after myocardial infarction.
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DOI：
10.1161/circulationaha.111.041749
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发表时间：
2011-11-22
期刊：
影响因子：
37.8
通讯作者：
Occluded Artery Trial Investigators
中科院分区：
文献类型：
--
作者：
Hochman JS;Reynolds HR;Dzavík V;Buller CE;Ruzyllo W;Sadowski ZP;Maggioni AP;Carvalho AC;Rankin JM;White HD;Goldberg S;Forman SA;Mark DB;Lamas GA;Occluded Artery Trial Investigators
尽管观察表明心肌梗死（MI）后延迟开通闭塞的梗死相关动脉（IRA）有好处，但闭塞动脉试验（OAT）在平均2.9年的随访中显示，死亡、再梗死和IV级心力衰竭（HF）的综合发生率没有降低。随访时间延长，以确定晚期趋势是否有利于两组治疗。OAT随机抽取2201例心肌梗死后24小时（日历天3-28天）稳定的IRA闭塞患者，排除严重诱导性缺血、静息性心绞痛、III-IV级HF和3支血管/左主干疾病。我们针对主要终点和心绞痛对入组患者进行了额外3年的延长随访（中位幸存者随访6年，最长9年，12,234例患者年）。PCI组与MED组的主要终点（HR 1.06, 95% CI 0.88-1.28）、致死性和非致死性心肌梗死（HR 1.25, 95% CI 0.89-1.75）、死亡和IV级心衰发生率相似。基线特征和治疗组对结果没有相互作用。在每次随访中，绝大多数患者没有报告心绞痛。随访早期PCI组心绞痛发生率较低；3年后，两组之间的差异始终<4例/ 100例，尽管PCI组在3年和5年有心绞痛减少的趋势，但两组之间的差异没有显著性差异。随访期间，PCI组7年PCI发生率为11.1%，而MED组为14.7% （HR 0.79, 95% CI 0.61-1.01）。p = 0.06)。OAT队列的长期随访提供了强有力的证据，表明在心肌梗死后亚急性期，稳定的IRA闭塞且没有严重诱导性缺血的患者进行常规PCI后，临床事件的长期发生率没有降低。
Despite observations suggesting a benefit for late opening of occluded infarct-related arteries (IRA) post-myocardial infarction (MI), the Occluded Artery Trial (OAT) demonstrated no reduction in the composite of death, reinfarction and class IV heart failure (HF) over 2.9-yearmean follow-up. Follow-up was extended to determine whether late trends would favor either treatment group. OAT randomized 2201 stable patients with IRA occlusion >24hours (calendar days3-28) after MI. Severe inducible ischemia, rest angina, class III-IV HF and 3-vessel/left main disease were excluded. We conducted extended followed up of enrolled patients for an additional 3 years for the primary endpoint and angina (6-year median survivor follow up, longest 9 years, 12,234 patient-years).Rates of the primary endpoint (HR 1.06, 95% CI 0.88-1.28), fatal and nonfatal MI (HR 1.25, 95% CI 0.89-1.75), death and class IV HF were similar for PCI vs. MED groups. No interaction between baseline characteristics and treatment group on outcomes were observed. The vast majority of patients at each follow-up visit did not report angina. There was less angina in the PCI group through early in follow-up; by 3 years the between group difference was consistently <4 patients per 100 treated and not significantly different though there was a trend toward less angina in the PCI group at 3 and 5 years. The 7-year rate of PCI of the IRA during follow up was 11.1% for the PCI group compared to 14.7% for the MED group (HR 0.79, 95% CI 0.61-1.01. p=0.06). Extended follow up of the OAT cohort provides robust evidence for no reduction of long-term rates of clinical events after routine PCI in stable patients with an occluded IRA and without severe inducible ischemia in the subacute phase post-MI.