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Updated: Jul 11, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Coronary intervention for persistent occlusion after myocardial infarction
Judith S Hochman1, Gervasio A Lamas, Christopher E Buller
1Cardiovascular Clinical Research Center, Leon Charney Division of Cardiology, New York University School of Medicine, New York 10016, USA.
Insights
Percutaneous coronary intervention (PCI) did not improve outcomes for stable patients with persistent total occlusion of the infarct-related artery. Optimal medical therapy alone is not inferior to PCI plus optimal medical therapy for reducing major adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Persistent total occlusion of the infarct-related coronary artery after myocardial infarction (MI) in stable, high-risk patients presents a therapeutic dilemma.
- The optimal management strategy, particularly the role of percutaneous coronary intervention (PCI) beyond the acute phase, remains unclear for preventing subsequent adverse events.
Purpose of the Study:
- To determine if routine percutaneous coronary intervention (PCI) and stenting, in addition to optimal medical therapy, reduces the risk of subsequent major adverse cardiovascular events compared to optimal medical therapy alone in stable high-risk patients with persistent total coronary artery occlusion post-MI.
Main Methods:
- A randomized controlled trial involving 2166 stable patients with total occlusion of the infarct-related artery 3 to 28 days after MI and high-risk criteria (ejection fraction <50% or proximal occlusion).
- Patients were assigned to either routine PCI with optimal medical therapy (n=1082) or optimal medical therapy alone (n=1084).
- The primary endpoint was a composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure over 4 years.
Main Results:
- The 4-year cumulative incidence of the primary composite endpoint was similar between groups (17.2% in PCI group vs. 15.6% in medical therapy group; hazard ratio [HR], 1.16; P=0.20).
- Rates of myocardial reinfarction were numerically higher in the PCI group (7.0% vs. 5.3%; HR, 1.36; P=0.13), with a trend toward excess nonfatal reinfarctions (6.9% vs. 5.0%; HR, 1.44; P=0.08).
- Rates of death and NYHA class IV heart failure were comparable between the PCI and medical therapy groups.
Conclusions:
- Routine percutaneous coronary intervention (PCI) did not reduce the occurrence of death, reinfarction, or heart failure in stable patients with persistent total occlusion of the infarct-related artery.
- A trend toward excess reinfarction was observed in the PCI group during the 4-year follow-up period.
- Optimal medical therapy alone appears to be a suitable strategy for managing these patients.
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].).
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