Occluded Artery Trial Results Have Minimal Impact

Subsequent guideline revisions have not been fully incorporated into U.S. hospitals

WEDNESDAY, July 13 (HealthDay News) -- The results of the Occluded Artery Trial (OAT) and subsequent guideline revisions have not, to date, been fully incorporated into clinical practice in many hospitals in the United States, according to a study published online July 11 in the Archives of Internal Medicine.

Marc W. Deyell, M.D., from the University of British Columbia in Vancouver, Canada, and colleagues assessed the impact of OAT results and the resulting change in guideline recommendations for percutaneous coronary intervention (PCI) for treating persistently occluded infarct related arteries. A total of 28,780 patients from 896 hospitals, enrolled in the CathPCI Registry from 2005 to 2008, undergoing catheterization more than 24 hours after myocardial infarction, with a totally occluded coronary artery and no major OAT exclusion criteria, were included. The monthly rates of occlusions treated with PCI after publication of the OAT results and guideline revisions were assessed. As diagnostic catheterization reporting is not mandatory, trends were examined in hospitals with the highest quartile for reporting diagnostic procedures.

The investigators observed no significant decrease in the adjusted monthly rate of PCI of occlusions following the publication of OAT or the guideline revisions. No significant decrease was seen in hospitals regularly reporting diagnostic catheterizations after the OAT publication, but there was a trend toward a decline following guideline revisions.

"Among this large cross-section of hospitals in the United States, we found only modest evidence that the results of the OAT and its incorporation into major guideline revisions have influenced cardiology and interventional cardiology practice over the subsequent one to two years," the authors write.

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