Related Experiment Video
Updated: Jul 9, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Percutaneous coronary intervention for late reperfusion after myocardial infarction in stable patients
John P A Ioannidis1, Demosthenes G Katritsis
1Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Insights
Percutaneous coronary intervention (PCI) offers no benefit for late revascularization of total coronary artery occlusion after myocardial infarction (MI) in stable patients. Meta-analysis shows no significant clinical outcome differences compared to medical therapy alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Conflicting results exist from randomized trials comparing mechanical recanalization with medical therapy for late total coronary artery occlusion post-myocardial infarction (MI).
- Stable patients with occluded arteries 1-45 days after MI were the focus of previous comparative studies.
Purpose of the Study:
- To perform a meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with medical therapy for late total coronary artery occlusion after MI.
- To evaluate the impact of PCI on clinical outcomes and left ventricular ejection fraction (EF) in this patient population.
Main Methods:
- Meta-analysis of six randomized trials and one substudy involving 2617 patients for clinical outcomes and 653 for EF.
- Outcomes assessed included death, MI, death or MI, congestive heart failure (CHF), and change in left ventricular EF.
Main Results:
- No statistically significant differences were observed in any clinical outcome between PCI and medical therapy.
- Trends suggested a potential increase in MI and a decrease in CHF with PCI, though not statistically significant.
- PCI demonstrated a slight superiority in improving left ventricular EF (2% increase).
Conclusions:
- Percutaneous coronary intervention does not appear to provide benefits for late revascularization of occluded arteries following myocardial infarction in stable patients.
- Earlier studies showing significant benefits for CHF and EF were contrasted by larger trials finding no benefit, indicating a complex relationship.
Background:
Results of randomized trials that have compared mechanical coronary artery recanalization versus medical therapy for total occlusion late after myocardial infarction (MI) have been conflicting.
Methods:
We performed a meta-analysis of randomized trials comparing percutaneous coronary intervention (PCI) with medical therapy in stable patients with an occluded artery 1 to 45 days after MI. Six trials and one substudy were included with data on 2617 patients for the clinical outcomes and 653 patients for determination of ejection fraction (EF) during follow-up. Outcomes included death, MI, death or MI, congestive heart failure (CHF), and change in left ventricular EF.
Results:
There were no statistically significant differences for any clinical outcome, with trends for an increase in MI (risk ratio 1.26, P = .19) and decrease in CHF (risk ratio 0.67, P = .19) in the PCI arm. The PCI arm showed a slight superiority in left ventricular EF (2%, 95% CI 0.1%-2.8%). Early smaller studies showed formally statistically significant benefits for CHF and EF, but the much larger Occluded Artery Trial and Total Occlusion Study of Canada 2 found no benefit. For CHF, the difference between early smaller studies and Occluded Artery Trial was beyond chance (P = .02).
Conclusions:
Percutaneous coronary intervention does not seem to confer any benefits when used for late revascularization of occluded arteries after MI in stable patients.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies