Long-term outcomes after a strategy of percutaneous coronary intervention of the infarct-related artery with drug-eluting stents or bare metal stents vs medical therapy alone in the Occluded Artery Trial (OAT)

Abstract

Background: The OAT, a randomized study of routine percutaneous coronary intervention or optimal medical therapy (MED) alone for the treatment of a totally occluded infarct-related artery in the subacute phase after myocardial infarction, showed similar rates of death, reinfarction and congestive heart failure (CHF) between study groups. Although most percutaneous coronary intervention patients were treated with bare metal stents (BMS), drug-eluting stents (DES) were also implanted in the latter part of the study. The aim of the study was to conduct an exploratory analysis of long-term outcomes for DES vs. BMS deployment vs. MED in the OAT.

Methods: Patients enrolled after February 2003 (when first DES was implanted) were followed (DES n = 79, BMS n = 393, MED n = 552) up to a maximum of 6 years (mean survivor follow-up 5.1 years).

Results: The 6-year occurrence of the composite end point of death, reinfarction and class IV CHF was similar [20.4% of DES, 18.9% of BMS and 18.4% of MED (P = .66)] as were the rates of the components of the primary end point. During the follow-up period, 33.4% of DES, 44.4% of BMS and 48.1% of MED patients, developed angina (P = .037). The rate of revascularization during follow up was 11.3%, 20.5% and 22.5% among these groups, respectively (P = .045).

Conclusions: There is no suggestion of reduced long-term risk of death, reinfarction or class IV CHF with DES usage compared to BMS or medical treatment alone. An association between DES use and freedom from angina and revascularization relative to medical therapy is suggested.

Figure 1

Kaplan-Meier curves for the OAT combined primary endpoint comparing DES, BMS, and MED patients. Log-rank test = 0.66.

Figure 2

Kaplan-Meier curves for myocardial infarction according to the universal definition of MI comparing DES, BMS and MED patients. Log-rank test = 0.18.

Figure 3

Kaplan-Meier curves for stent thrombosis (Type 4b) MI according to the Universal Definition of MI comparing DES and BMS patients. Log-rank test = 0.17.

Figure 4

Kaplan-Meier curve for angina comparing DES, BMS, and MED patients. Log-rank test P = .04.

Figure 5

Kaplan-Meier curves for revascularization comparing DES, BMS, and MED patients. Log-rank test = .45.