PMID- 17105759
OWN - NLM
STAT- MEDLINE
DCOM- 20061213
LR  - 20220408
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Print)
IS  - 0028-4793 (Linking)
VI  - 355
IP  - 23
DP  - 2006 Dec 7
TI  - Coronary intervention for persistent occlusion after myocardial infarction.
PG  - 2395-407
AB  - BACKGROUND: It is unclear whether stable, high-risk patients with persistent 
      total occlusion of the infarct-related coronary artery identified after the 
      currently accepted period for myocardial salvage has passed should undergo 
      percutaneous coronary intervention (PCI) in addition to receiving optimal medical 
      therapy to reduce the risk of subsequent events. METHODS: We conducted a 
      randomized study involving 2166 stable patients who had total occlusion of the 
      infarct-related artery 3 to 28 days after myocardial infarction and who met a 
      high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of 
      these patients, 1082 were assigned to routine PCI and stenting with optimal 
      medical therapy, and 1084 were assigned to optimal medical therapy alone. The 
      primary end point was a composite of death, myocardial reinfarction, or New York 
      Heart Association (NYHA) class IV heart failure. RESULTS: The 4-year cumulative 
      primary event rate was 17.2% in the PCI group and 15.6% in the medical therapy 
      group (hazard ratio for death, reinfarction, or heart failure in the PCI group as 
      compared with the medical therapy group, 1.16; 95% confidence interval [CI], 0.92 
      to 1.45; P=0.20). Rates of myocardial reinfarction (fatal and nonfatal) were 7.0% 
      and 5.3% in the two groups, respectively (hazard ratio, 1.36; 95% CI, 0.92 to 
      2.00; P=0.13). Rates of nonfatal reinfarction were 6.9% and 5.0%, respectively 
      (hazard ratio, 1.44; 95% CI, 0.96 to 2.16; P=0.08); only six reinfarctions (0.6%) 
      were related to assigned PCI procedures. Rates of NYHA class IV heart failure 
      (4.4% vs. 4.5%) and death (9.1% vs. 9.4%) were similar. There was no interaction 
      between treatment effect and any subgroup variable (age, sex, race or ethnic 
      group, infarct-related artery, ejection fraction, diabetes, Killip class, and the 
      time from myocardial infarction to randomization). CONCLUSIONS: PCI did not 
      reduce the occurrence of death, reinfarction, or heart failure, and there was a 
      trend toward excess reinfarction during 4 years of follow-up in stable patients 
      with occlusion of the infarct-related artery 3 to 28 days after myocardial 
      infarction. (ClinicalTrials.gov number, NCT00004562 [ClinicalTrials.gov].).
CI  - Copyright 2006 Massachusetts Medical Society.
FAU - Hochman, Judith S
AU  - Hochman JS
AD  - Cardiovascular Clinical Research Center, Leon Charney Division of Cardiology, New 
      York University School of Medicine, New York 10016, USA.
FAU - Lamas, Gervasio A
AU  - Lamas GA
FAU - Buller, Christopher E
AU  - Buller CE
FAU - Dzavik, Vladimir
AU  - Dzavik V
FAU - Reynolds, Harmony R
AU  - Reynolds HR
FAU - Abramsky, Staci J
AU  - Abramsky SJ
FAU - Forman, Sandra
AU  - Forman S
FAU - Ruzyllo, Witold
AU  - Ruzyllo W
FAU - Maggioni, Aldo P
AU  - Maggioni AP
FAU - White, Harvey
AU  - White H
FAU - Sadowski, Zygmunt
AU  - Sadowski Z
FAU - Carvalho, Antonio C
AU  - Carvalho AC
FAU - Rankin, Jamie M
AU  - Rankin JM
FAU - Renkin, Jean P
AU  - Renkin JP
FAU - Steg, P Gabriel
AU  - Steg PG
FAU - Mascette, Alice M
AU  - Mascette AM
FAU - Sopko, George
AU  - Sopko G
FAU - Pfisterer, Matthias E
AU  - Pfisterer ME
FAU - Leor, Jonathan
AU  - Leor J
FAU - Fridrich, Viliam
AU  - Fridrich V
FAU - Mark, Daniel B
AU  - Mark DB
FAU - Knatterud, Genell L
AU  - Knatterud GL
CN  - Occluded Artery Trial Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT00004562
GR  - U01 HL062509-05S1/HL/NHLBI NIH HHS/United States
GR  - U01 HL062257/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509-05/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509-01A1/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509-04/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509-02/HL/NHLBI NIH HHS/United States
GR  - U01 HL062511/HL/NHLBI NIH HHS/United States
GR  - R01 HL067683/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509-03/HL/NHLBI NIH HHS/United States
GR  - R01 HL67683/HL/NHLBI NIH HHS/United States
GR  - U01 HL062509/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20061114
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
SB  - IM
CIN - N Engl J Med. 2006 Dec 7;355(23):2475-7. PMID: 17105760
CIN - Nat Clin Pract Cardiovasc Med. 2007 May;4(5):250-1. PMID: 17375052
CIN - N Engl J Med. 2007 Apr 19;356(16):1681; author reply 1683-4. PMID: 17442915
CIN - N Engl J Med. 2007 Apr 19;356(16):1682; author reply 1683-4. PMID: 17447281
CIN - N Engl J Med. 2007 Apr 19;356(16):1682; author reply 1683-4. PMID: 17447282
CIN - N Engl J Med. 2007 Apr 19;356(16):1681-2; author reply 1683-4. PMID: 17447283
CIN - N Engl J Med. 2007 Apr 19;356(16):1681; author reply 1683-4. PMID: 17447284
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Combined Modality Therapy
MH  - Coronary Stenosis/complications/drug therapy/*therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/epidemiology/etiology
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Mortality
MH  - Myocardial Infarction/complications/*therapy
MH  - Proportional Hazards Models
MH  - Secondary Prevention
MH  - Stents
PMC - PMC1995554
MID - NIHMS27202
EDAT- 2006/11/16 09:00
MHDA- 2006/12/14 09:00
PMCR- 2007/10/05
CRDT- 2006/11/16 09:00
PHST- 2006/11/16 09:00 [pubmed]
PHST- 2006/12/14 09:00 [medline]
PHST- 2006/11/16 09:00 [entrez]
PHST- 2007/10/05 00:00 [pmc-release]
AID - NEJMoa066139 [pii]
AID - 10.1056/NEJMoa066139 [doi]
PST - ppublish
SO  - N Engl J Med. 2006 Dec 7;355(23):2395-407. doi: 10.1056/NEJMoa066139. Epub 2006 
      Nov 14.