Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Mar 1;109(5):614-9.
doi: 10.1016/j.amjcard.2011.10.015. Epub 2011 Dec 14.

Comparison of late results of percutaneous coronary intervention among stable patients ≤65 versus >65 years of age with an occluded infarct related artery (from the Occluded Artery Trial)

Adam H Skolnick  1 , Harmony R Reynolds, Harvey D White, Venu Menon, Antonio C Carvalho, Aldo P Maggioni, Camille A Pearte, Luis Gruberg, Rudyney E U Azevedo, Erwin Schroeder, Sandra A Forman, Gervasio A Lamas, Judith S Hochman, Vladimír Džavík
Affiliations
Randomized Controlled Trial

Comparison of late results of percutaneous coronary intervention among stable patients ≤65 versus >65 years of age with an occluded infarct related artery (from the Occluded Artery Trial)

Adam H Skolnick et al. Am J Cardiol. .

Abstract

Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. The primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged ≤65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). The 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). The rate of early PCI complications was low in the 2 age groups. The trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. In conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Over 7 years of follow-up, cumulative rates of death, MI or Class IV heart failure are significantly higher among those >65 for both PCI and MED.
Figure 2
Figure 2
Bar graph demonstrating the reporting of Angina at 4 months and yearly follow-up among younger and older PCI and MED patients.
See this image and copyright information in PMC

References

    1. Dzavík V, Buller CE, Lamas GA, Rankin JM, Mancini GB, Cantor WJ, Carere RJ, Ross JR, Atchison D, Forman S, Thomas B, Buszman P, Vozzi C, Glanz A, Cohen EA, Meciar P, Devlin G, Mascette A, Sopko G, Knatterud GL, Hochman JS TOSCA-2 Investigators. 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. Circulation. 2006;114:2449–2457. - PMC - PubMed
    1. Hochman JS, Lamas GA, Buller CE, Džavík V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z, Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006;355:2395–2407. - PMC - PubMed
    1. Hochman JS, Lamas GA, Knatterud GL, Buller CE, Dzavik V, Mark DB, Reynolds HR, White HD. Design and methodology of the Occluded Artery Trial (OAT) Am Heart J. 2005;150:627–642. - PubMed
    1. Hochman JS, Reynolds HR, Dzavik V, Buller CE, Ruzyllo W, Sadowski ZP, Maggioni AP, Carvalho AC, Rankin JM, Goldberg S, Forman SA, Mark DB, Lamas GA. Persistent Lack of Benefit of Late Revascularization of the Occluded Coronary Artery Post-MI - The Occluded Artery Trial (OAT) Long Term Results. Circulation. 2011 (IN PRESS)
    1. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.

Publication types

MeSH terms