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No Benefit of PCI for Blockage After Heart Attack

Percutaneous coronary intervention provides no benefit over medical therapy

THURSDAY, Oct. 23 (HealthDay News) -- Percutaneous coronary intervention (PCI) provides no benefit over medical therapy in treating patients with a persistently occluded infarct-related artery after a heart attack, according to study findings published in the October issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Mariusz Kruk, M.D., Ph.D., from the Institute of Cardiology in Warsaw, Poland, and colleagues randomly assigned 2,201 stable patients with a myocardial infarction-related artery occlusion to PCI or medical therapy.

After a mean of 3.2 years, the researchers found that the five-year rate of death, reinfarction and heart failure was similar for the PCI and medical therapy groups (18.9 versus 16.1 percent, hazard ratio 1.14). The rates of total mortality and other outcomes were similar for both treatments across the risk spectrum. Independent predictors of death, reinfarction and heart failure were a history of heart failure (HR, 2.06), peripheral vascular disease (HR, 1.93), diabetes (HR, 1.49), rales (HR, 1.88), decreasing ejection fraction (HR, 1.48 per 10 percent decrease), and fewer days between myocardial infarction and randomization (HR, 1.11 per 10 mL/min/1.73 meter2).

"This study not only confirms the unexpected and negative results of the main study (no benefit of PCI) but also extends the results to all patients regardless of their risk and suggests that PCI may be responsible for a worse prognosis for patients within the high-risk tertile who could theoretically derive major benefit from revascularization as compared with low- or medium-risk patients," David Antoniucci, M.D., from Careggi Hospital in Florence, Italy, writes in an accompanying editorial.

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