Randomized trial of percutaneous coronary intervention for subacute infarct-related coronary artery occlusion to achieve long-term patency and improve ventricular function: the Total Occlusion Study of Canada (TOSCA)-2 trial
| Autor: | Anthony Glanz, James M. Rankin, Peter Mečiar, John Ross, George Sopko, Paweł Buszman, Boban Thomas, Genell L. Knatterud, Eric A. Cohen, Christopher E. Buller, Sandra A. Forman, G.B. John Mancini, Gerald Devlin, Vladimir Dzavik, Warren J. Cantor, Alice M. Mascette, Ronald J. Carere, Gervasio A. Lamas, Judith S. Hochman, Carlos Vozzi, Deborah J. Atchison |
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| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Canada Endpoint Determination medicine.medical_treatment Myocardial Infarction Coronary Artery Disease Coronary artery disease Ventricular Function Left Physiology (medical) Angioplasty Internal medicine medicine Myocardial Revascularization Humans cardiovascular diseases Myocardial infarction Artery occlusion Angioplasty Balloon Coronary Vascular Patency Aged Aged 80 and over Ejection fraction business.industry Percutaneous coronary intervention Stroke Volume Middle Aged medicine.disease Surgery Treatment Outcome Conventional PCI Cardiology Disease Progression Myocardial infarction complications Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP |
| Popis: | Background— In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function. Methods and Results— Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy–only patients had a patent IRA ( P P P =0.47). Median change (interquartile range) in LV end-systolic volume index was −0.5 (−9.3 to 5.0) versus 1.0 (−5.7 to 7.3) mL/m 2 ( P =0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (−8.2 to 13.3) versus 5.3 (−4.6 to 23.2) mL/m 2 ( P =0.07) in the PCI (n=86) and medical therapy–only (n=76) groups, respectively. Conclusions— PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI. |
| Databáze: | OpenAIRE |
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