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Zagler A, Heimowitz TB, Escolar E, Hussein SJ, Yousef ZR, Steg PG, Dzavik V, Hochman JS, Vignola PA, Lamas GA. Late Intervention on an Occluded Infarct-Related Artery: A Meta-analysis of the Randomized Controlled Trials. Clin Med Cardiol 2007. [DOI: 10.4137/cmc.s356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context Late intervention to open an occluded infarct-related artery (IRA) after initial acute myocardial infarction was postulated to lead to clinical benefit. Objective To conduct a meta-analysis of the randomized trials. Study Selection Eligibility criteria were: 1) randomized trials comparing percutaneous coronary intervention (PCI) in a totally occluded artery (TIMI flow 0-1) versus medical therapy, 2) in stable post myocardial infarction (MI) patients without spontaneous or low level exercise induced ischemia, 3) trials with a time from the onset of symptoms to randomization >24 hours, but <6 weeks, and 4) trials reporting mortality and recurrent MI as an endpoint. Of 961 citations reviewed, 3 disagreements were easily resolved by discussion and 6 trials were selected for inclusion. Data Synthesis The primary endpoint was the composite of recurrent MI or death. The secondary endpoints were the development of heart failure or recurrent myocardial infarction. In a meta-analysis of the 6 trials, which included 2642 patients, late intervention of an IRA had a RR of death or recurrent MI of 1.12 (95% CI 0.91-1.38). Data regarding the development of heart failure was available for 4 trials. In a meta-analysis of these 4 trials, which included 2527 patients, late intervention of an IRA had a RR of 0.79 (95% CI 0.58-1.08). Data regarding the occurrence of recurrent MI was available for 5 trials. In a meta-analysis of these 5 trials, which included 2598 patients, late intervention of an IRA had a RR of 1.28 (95% CI 0.91-1.79). Conclusions Our meta-analysis of the currently available randomized data addressing late intervention of an occluded IRA failed to reveal clinical benefit with regard to the clinical endpoints of death, heart failure or reinfarction. The trend towards an increase in reinfarction among the PCI treated patients suggested by the Open Artery Trial (OAT) investigators persisted, but did not achieve statistical significance.
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Affiliation(s)
| | | | | | | | | | | | - Vladimir Dzavik
- University Health Network, Toronto General Hospital, Toronto
| | - Judith S. Hochman
- Cardiovascular Clinical Research Center, New York University School of Mdeicine, New York, NY
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Kim CM. The Open Artery Hypothesis. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.6.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Chul-Min Kim
- Cardiology Division, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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