OBJECTIVE: We sought to conduct a randomized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infarction (AMI). BACKGROUND: In the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that an open infarct related artery benefits healing post AMI. METHODS: Of 223 patients enrolled with Q-wave anterior AMI, 66 with isolated persistent occlusion of the left anterior descending coronary artery (LAD) were randomized to the following treatments: 1) medical therapy (closed artery group; n = 34) or 2) late intervention and stent to the LAD + medical therapy (open artery group; n = 32). The study was powered to compare left ventricular (LV) end-systolic volume between the two groups 12 months post AMI. RESULTS:Late intervention 26 +/- 18 days post AMI resulted in significantly greater LV end-systolic and end-diastolic volumes at 12 months than medical therapy alone (106.6 +/- 37.5 ml vs. 79.7 +/- 34.4 ml, p < 0.01 and 162.0 +/- 51.4 ml vs. 130.1 +/- 46.1 ml, p < 0.01, respectively). Exercise duration and peak workload significantly increased in both groups from 6 weeks to 12 months post AMI, although absolute values were greater in the open artery group. Quality of life scores tended to deteriorate during this time interval in the closed artery patients but remained unchanged in the open artery patients. Coronary angiography at 1 year documented a low incidence of intergroup cross-over (spontaneous recanalization in 19% and closure in 11%). CONCLUSIONS: In the present study, recanalization of occluded infarct-related arteries in symptom-free patients approximately 1 month post AMI had an adverse effect on remodeling but tended to increase exercise tolerance and improve quality of life.
RCT Entities:
OBJECTIVE: We sought to conduct a randomized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infarction (AMI). BACKGROUND: In the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that an open infarct related artery benefits healing post AMI. METHODS: Of 223 patients enrolled with Q-wave anterior AMI, 66 with isolated persistent occlusion of the left anterior descending coronary artery (LAD) were randomized to the following treatments: 1) medical therapy (closed artery group; n = 34) or 2) late intervention and stent to the LAD + medical therapy (open artery group; n = 32). The study was powered to compare left ventricular (LV) end-systolic volume between the two groups 12 months post AMI. RESULTS: Late intervention 26 +/- 18 days post AMI resulted in significantly greater LV end-systolic and end-diastolic volumes at 12 months than medical therapy alone (106.6 +/- 37.5 ml vs. 79.7 +/- 34.4 ml, p < 0.01 and 162.0 +/- 51.4 ml vs. 130.1 +/- 46.1 ml, p < 0.01, respectively). Exercise duration and peak workload significantly increased in both groups from 6 weeks to 12 months post AMI, although absolute values were greater in the open artery group. Quality of life scores tended to deteriorate during this time interval in the closed artery patients but remained unchanged in the open artery patients. Coronary angiography at 1 year documented a low incidence of intergroup cross-over (spontaneous recanalization in 19% and closure in 11%). CONCLUSIONS: In the present study, recanalization of occluded infarct-related arteries in symptom-free patients approximately 1 month post AMI had an adverse effect on remodeling but tended to increase exercise tolerance and improve quality of life.
Authors: Vladimír Dzavík; Christopher E Buller; Gervasio A Lamas; James M Rankin; G B John Mancini; Warren J Cantor; Ronald J Carere; John R Ross; Deborah Atchison; Sandra Forman; Boban Thomas; Pawel Buszman; Carlos Vozzi; Anthony Glanz; Eric A Cohen; Peter Meciar; Gerald Devlin; Alice Mascette; George Sopko; Genell L Knatterud; Judith S Hochman Journal: Circulation Date: 2006-11-14 Impact factor: 29.690
Authors: Irene M Lang; Sandra A Forman; Aldo P Maggioni; Witold Ruzyllo; Jean Renkin; Carlos Vozzi; P Gabriel Steg; Jose-Maria Hernandez-Garcia; Krzysztof Zmudka; Manuel Jimenez-Navarro; George Sopko; Gervasio A Lamas; Judith S Hochman Journal: EuroIntervention Date: 2009-11 Impact factor: 6.534
Authors: Judith S Hochman; Gervasio A Lamas; Christopher E Buller; Vladimir Dzavik; Harmony R Reynolds; Staci J Abramsky; Sandra Forman; Witold Ruzyllo; Aldo P Maggioni; Harvey White; Zygmunt Sadowski; Antonio C Carvalho; Jamie M Rankin; Jean P Renkin; P Gabriel Steg; Alice M Mascette; George Sopko; Matthias E Pfisterer; Jonathan Leor; Viliam Fridrich; Daniel B Mark; Genell L Knatterud Journal: N Engl J Med Date: 2006-11-14 Impact factor: 91.245
Authors: Christopher E Buller; Jamie M Rankin; Ronald G Carere; Pawel E Buszman; Matthias E Pfisterer; Vladimir Dzavik; Boban Thomas; Sandra Forman; Witold Ruzyllo; G B John Mancini; Lampros K Michalis; Pedro F Abreu; Gervasio A Lamas; Judith S Hochman Journal: Am Heart J Date: 2009-09 Impact factor: 4.749