Reinfarction after percutaneous coronary intervention or medical management using the universal definition in patients with total occlusion after myocardial infarction: results from long-term follow-up of the Occluded Artery Trial (OAT) cohort.
Reinfarction after percutaneous coronary intervention or medical management using the universal definition in patients with total occlusion after myocardial infarction: results from long-term follow-up of the Occluded Artery Trial (OAT) cohort.
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DOI：
10.1016/j.ahj.2012.01.016
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发表时间：
2012-04
影响因子：
4.8
通讯作者：
Hochman, Judith S.
中科院分区：
文献类型：
--
作者：
White, Harvey D.;Reynolds, Harmony R.;Carvalho, Antonio C.;Pearte, Camille A.;Liu, Li;Martin, C. Edwin;Knatterud, Genell L.;Dzavik, Vladimir;Kruk, Mariusz;Steg, Philippe Gabriel;Cantor, Warren J.;Menon, Venu;Lamas, Gervasio A.;Hochman, Judith S.
动脉闭塞试验 (OAT) 将 2201 名在心肌梗塞 (MI) 后第 3-28 天（>24 小时）完全闭塞的梗塞相关动脉患者随机分组接受经皮冠状动脉介入治疗 (PCI) 或药物治疗 (MED)。平均随访 2.9 年或 6 年时，死亡、再梗塞或心力衰竭等主要终点没有差异。然而，在随机接受 PCI 的患者中，存在再梗塞增加的趋势。我们根据通用定义分析了再梗塞的特征和类型。使用 Cox 比例风险模型确定再梗死的独立预测因子，随访时间长达 9 年。再次梗塞 169 例； 9.4% PCI 对比 8.0% MED，HR 1.31，95% CI 0.97 −1.77，p=0.08。各组中自发性再梗死（1 型）的发生频率相似； 4.9% PCI 对比 6.7% MED，HR 0.78，95% CI 0.53 – 1.15，p=0.21。两组中 2 型（继发性）和 3 型（猝死）心肌梗死发生率相似。 4a 型再梗塞（与方案或重复 PCI 相关）、0.8% PCI 与 0.1% MED 相比有所增加，p=0.01，4b 型再梗塞（支架内血栓形成）有所增加； 2.7% PCI 对比 0.6% MED，p<0.001。再梗塞的多变量预测因素包括进入研究前的 PCI 病史 (p=0.001)、糖尿病 (p=0.005) 以及没有新的梗死 Q 波 (p=0.01)。有一种趋势是 reMI 与 PCI 的结合更加频繁。在心梗后晚期，对病情稳定的患者开放与梗塞相关的闭塞动脉，会使他们面临与再闭塞和支架内血栓形成相关的后续再梗塞的风险。
The Occluded Artery Trial (OAT) randomized 2201 patients with a totally occluded infarct-related artery on days 3–28 (>24 hours) following myocardial infarction (MI) to percutaneous coronary intervention (PCI) or medical treatment (MED). There was no difference in the primary endpoint of death, reinfarction or heart failure at 2.9 year or 6-year mean follow-up. However in patients randomized to PCI there was a trend for an increase in reinfarction. We analyzed the characteristics and types of reinfarction according to the universal definition. Independent predictors of reinfarction were determined using Cox proportional hazard models with follow up to 9 years. There were 169 reinfarctions; 9.4% PCI vs 8.0% MED, HR 1.31, 95% CI 0.97 −1.77, p=0.08. Spontaneous reinfarction (type 1) occurred with similar frequency in the groups; 4.9% PCI vs 6.7% MED, HR 0.78, 95% CI 0.53 – 1.15, p=0.21. Rates of type 2 (secondary) and 3 (sudden death) MI were similar in both groups. There was an increase in type 4a reinfarctions (related to protocol or repeat PCI), 0.8% PCI vs 0.1% MED, p=0.01 and type 4b reinfarctions (stent thrombosis); 2.7% PCI vs 0.6% MED, p<0.001. Multivariate predictors of reinfarction were history of PCI prior to study entry (p=0.001), diabetes (p=0.005), and absence of new Q waves with the index infarction (p=0.01). There was a trend for reMI to be more frequent with PCI. Opening an occluded infarct-related artery in stable patients late post-MI exposes them to a risk of subsequent reinfarction related to reocclusion and stent thrombosis.
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影响因子：
2
作者：
Pencina, MJ;D'Agostino, RB
通讯作者：
D'Agostino, RB
影响因子：
158.5
作者：
Hochman, Judith S.;Lamas, Gervasio A.;Knatterud, Genell L.
通讯作者：
Knatterud, Genell L.
影响因子：
37.8
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
通讯作者：
Occluded Artery Trial Investigators
影响因子：
8.8
作者：
Peto R;Pike MC;Armitage P;Breslow NE;Cox DR;Howard SV;Mantel N;McPherson K;Peto J;Smith PG
通讯作者：
Smith PG
影响因子：
37.8
作者：
Cutlip, Donald E.;Windecker, Stephan;Serruys, Patrick W.
通讯作者：
Serruys, Patrick W.