Document Detail


The Occluded Artery Trial (OAT) Viability Ancillary Study (OAT-NUC): influence of infarct zone viability on left ventricular remodeling after percutaneous coronary intervention versus optimal medical therapy alone.
MedLine Citation:
PMID:  21392619     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Occluded Artery Trial (OAT) showed no difference in outcomes between percutaneous coronary intervention (PCI) versus optimal medical therapy (MED) in patients with persistent total occlusion of the infarct-related artery 3 to 28 days post-myocardial infarction. Whether PCI may benefit a subset of patients with preservation of infarct zone (IZ) viability is unknown.
METHODS AND RESULTS: The OAT nuclear ancillary study hypothesized that (1) IZ viability influences left ventricular (LV) remodeling and that (2) PCI as compared with MED attenuates adverse remodeling in post-myocardial infarction patients with preserved viability. Enrolled were 124 OAT patients who underwent resting nitroglycerin-enhanced technetium-99m sestamibi single-photon emission computed tomography (SPECT) before OAT randomization, with repeat imaging at 1 year. All images were quantitatively analyzed for infarct size, IZ viability, LV volumes, and function in a core laboratory. At baseline, mean infarct size was 26% ± 18 of the LV, mean IZ viability was 43% ± 8 of peak uptake, and most patients (70%) had at least moderately retained IZ viability. There were no significant differences in 1-year end-diastolic or end-systolic volume change between those with severely reduced versus moderately retained IZ viability, or when compared by treatment assignment PCI versus MED. In multivariable models, increasing baseline viability independently predicted improvement in ejection fraction (P = .005). There was no interaction between IZ viability and treatment assignment for any measure of LV remodeling.
CONCLUSIONS: In the contemporary era of MED, PCI of the infarct-related artery compared with MED alone does not impact LV remodeling irrespective of IZ viability.
Authors:
James E Udelson; Camille A Pearte; Carey D Kimmelstiel; Mariusz Kruk; Joseph A Kufera; Sandra A Forman; Anna Teresinska; Bartosz Bychowiec; Jose Antonio Marin-Neto; Thomas Höchtl; Eric A Cohen; Paulo Caramori; Benita Busz-Papiez; Christopher Adlbrecht; Zygmunt P Sadowski; Witold Ruzyllo; Debra J Kinan; Gervasio A Lamas; Judith S Hochman
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  161     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-11     Completed Date:  2011-05-26     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-21     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Mosby, Inc. All rights reserved.
Affiliation:
Tufts Medical Center, Boston, MA 02111, USA. judelson@tuftsmedicalcenter.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary
Coronary Occlusion / pathology,  therapy
Female
Humans
Male
Middle Aged
Multicenter Studies as Topic
Multivariate Analysis
Myocardial Infarction / drug therapy,  pathology*,  therapy
Stroke Volume
Tomography, Emission-Computed, Single-Photon
Ventricular Dysfunction, Left / pathology,  physiopathology
Ventricular Remodeling*
Grant Support
ID/Acronym/Agency:
R01 HL 075456-04S1/HL/NHLBI NIH HHS; R01 HL075456/HL/NHLBI NIH HHS; R01 HL075456-01/HL/NHLBI NIH HHS; R01 HL075456-02/HL/NHLBI NIH HHS; R01 HL075456-03/HL/NHLBI NIH HHS; R01 HL075456-03S1/HL/NHLBI NIH HHS; R01 HL075456-04/HL/NHLBI NIH HHS; R01 HL075456-04S1/HL/NHLBI NIH HHS; U01HL062509/HL/NHLBI NIH HHS; U01HL062511/HL/NHLBI NIH HHS
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