BACKGROUND: Results of randomized trials that have compared mechanical coronary artery recanalization versus medical therapy for total occlusion late after myocardial infarction (MI) have been conflicting. METHODS: We performed a meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with medical therapy in stable patients with an occluded artery 1 to 45 days after MI. Six trials and one substudy were included with data on 2617 patients for the clinical outcomes and 653 patients for determination of ejection fraction (EF) during follow-up. Outcomes included death, MI, death or MI, congestive heart failure (CHF), and change in left ventricular EF. RESULTS: There were no statistically significant differences for any clinical outcome, with trends for an increase in MI (risk ratio 1.26, P = .19) and decrease in CHF (risk ratio 0.67, P = .19) in the PCI arm. The PCI arm showed a slight superiority in left ventricular EF (2%, 95% CI 0.1%-2.8%). Early smaller studies showed formally statistically significant benefits for CHF and EF, but the much larger Occluded Artery Trial and Total Occlusion Study of Canada 2 found no benefit. For CHF, the difference between early smaller studies and Occluded Artery Trial was beyond chance (P = .02). CONCLUSIONS: Percutaneous coronary intervention does not seem to confer any benefits when used for late revascularization of occluded arteries after MI in stable patients.
BACKGROUND: Results of randomized trials that have compared mechanical coronary artery recanalization versus medical therapy for total occlusion late after myocardial infarction (MI) have been conflicting. METHODS: We performed a meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with medical therapy in stable patients with an occluded artery 1 to 45 days after MI. Six trials and one substudy were included with data on 2617 patients for the clinical outcomes and 653 patients for determination of ejection fraction (EF) during follow-up. Outcomes included death, MI, death or MI, congestive heart failure (CHF), and change in left ventricular EF. RESULTS: There were no statistically significant differences for any clinical outcome, with trends for an increase in MI (risk ratio 1.26, P = .19) and decrease in CHF (risk ratio 0.67, P = .19) in the PCI arm. The PCI arm showed a slight superiority in left ventricular EF (2%, 95% CI 0.1%-2.8%). Early smaller studies showed formally statistically significant benefits for CHF and EF, but the much larger Occluded Artery Trial and Total Occlusion Study of Canada 2 found no benefit. For CHF, the difference between early smaller studies and Occluded Artery Trial was beyond chance (P = .02). CONCLUSIONS: Percutaneous coronary intervention does not seem to confer any benefits when used for late revascularization of occluded arteries after MI in stable patients.
Authors: Marc W Deyell; Christopher E Buller; Louis H Miller; Tracy Y Wang; David Dai; Gervasio A Lamas; Vankeepuram S Srinivas; Judith S Hochman Journal: Arch Intern Med Date: 2011-07-11
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Authors: Nikhil V Joshi; Iqbal Toor; Anoop S V Shah; Kathryn Carruthers; Alex T Vesey; Shirjel R Alam; Andrew Sills; Teng Y Hoo; Adam J Melville; Sarah P Langlands; William S A Jenkins; Neal G Uren; Nicholas L Mills; Alison M Fletcher; Edwin J R van Beek; James H F Rudd; Keith A A Fox; Marc R Dweck; David E Newby Journal: J Am Heart Assoc Date: 2015-08-27 Impact factor: 5.501