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AHA: Better Never Than Late Reperfusion After MI

Reperfusion three to 28 days after myocardial infarction offers no benefit and may even be harmful for patients who are stable

TUESDAY, Nov. 14 (HealthDay News) -- Stable patients with totally occluded coronary arteries do not benefit from percutaneous coronary intervention when given three to 28 days after a myocardial infarction and may even be harmed by the practice, according to a study presented at the American Heart Association's Scientific Sessions in Chicago. The findings were also published online Nov. 14 in the New England Journal of Medicine.

Judith Hochman, M.D., of New York University School of Medicine, and colleagues from the Occluded Artery Trial (OAT) randomized 2,166 stable patients to optimal medical therapy or angioplasty plus stenting. During a mean three-year follow-up, patients treated with late reperfusion did no better than medication-treated patients in terms of mortality, repeat myocardial infarction and heart failure. And there was a trend towards more repeat myocardial infarctions in the reperfusion-treated group.

In a second study, a subset of the OAT trial known as TOSCA-2 (Total Occlusion Study of Canada), Vladimir Dzavik, M.D., of the University Health Network in Toronto reported on 381 patients who received late reperfusion or medication. Ninety-three percent of infarct-related arteries could be opened with angioplasty plus stenting and 83 percent were open one year later. In comparison, 25 percent of arteries spontaneously opened in medication-treated patients. However, both groups had similar ejection fractions after one year.

"If you are a stable patient there is no benefit to open that artery late, days to weeks after that heart attack," said Hochman. The authors emphasized that high-risk patients were excluded, including those with left main or 3-vessel disease, angina at rest or low-threshold angina, cardiogenic shock or major heart failure. "We are not in any way saying that patients who are having significant severe symptoms and have an occluded artery, that they should not have PCI," said Dzavik.

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