Document Detail


Infarct artery distribution and clinical outcomes in occluded artery trial subjects presenting with non-ST-segment elevation myocardial infarction (from the long-term follow-up of Occluded Artery Trial [OAT]).
MedLine Citation:
PMID:  23351464     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We hypothesized that the insensitivity of the electrocardiogram in identifying acute circumflex occlusion would result in differences in the distribution of the infarct-related artery (IRA) between patients with non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI enrolled in the Occluded Artery Trial. We also sought to evaluate the effect of percutaneous coronary intervention to the IRA on the clinical outcomes for patients with NSTEMI. Overall, those with NSTEMI constituted 13% (n = 283) of the trial population. The circumflex IRA was overrepresented in the NSTEMI group compared to the STEMI group (42.5 vs 11.2%; p <0.0001). The 7-year clinical outcomes for the patients with NSTEMI randomized to percutaneous coronary intervention and optimal medical therapy versus optimal medical therapy alone were similar for the primary composite of death, myocardial infarction, and class IV congestive heart failure (22.3% vs 20.2%, hazard ratio 1.20, 99% confidence interval 0.60 to 2.40; p = 0.51) and the individual end points of death (13.8% vs 17.0%, hazard ratio 0.82, 99% confidence interval 0.37 to 1.84; p = 0.53), myocardial infarction (6.1 vs 5.1%, hazard ratio 1.11, 99% confidence interval 0.28 to 4.41; p = 0.84), and class IV congestive heart failure (6.7% vs 6.0%, hazard ratio 1.50, 99% confidence interval 0.37 to 6.02; p = 0.45). No interaction was seen between the electrocardiographically determined myocardial infarction type and treatment effect (p = NS). In conclusion, the occluded circumflex IRA is overrepresented in the NSTEMI population. Consistent with the overall trial results, stable patients with NSTEMI and a totally occluded IRA did not benefit from randomization to percutaneous coronary intervention.
Authors:
Venu Menon; Witold Ruzyllo; Antonio C Carvalho; Jose Marconi Almeida de Sousa; Sandra A Forman; Krystyna Jaworska; Gervasio A Lamas; Marek Roik; Christophe Thuaire; Yoav Turgeman; Judith S Hochman
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2013-01-22
Journal Detail:
Title:  The American journal of cardiology     Volume:  111     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-05-16     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  930-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Confidence Intervals
Coronary Occlusion / complications,  diagnosis*,  mortality,  therapy*
Electrocardiography*
Female
Heart Failure / etiology
Humans
Male
Middle Aged
Myocardial Infarction / complications,  diagnosis*,  mortality,  therapy*
Percutaneous Coronary Intervention
Proportional Hazards Models
Retrospective Studies
Sensitivity and Specificity
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
U01 HL062509/HL/NHLBI NIH HHS; U01 HL062509/HL/NHLBI NIH HHS; U01 HL062511/HL/NHLBI NIH HHS
Comments/Corrections

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