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 - 06/08/11
, Camille A. Pearte, MD, MPH b, Carey D. Kimmelstiel, MD a, Mariusz Kruk, MD e, Joseph A. Kufera, MA c, Sandra A. Forman, MA d, Anna Teresinska, MD e, Bartosz Bychowiec, MD f, Jose Antonio Marin-Neto, MD g, Thomas Höchtl, MD h, Eric A. Cohen, MD i, Paulo Caramori, MD, PhD j, Benita Busz-Papiez, MD k, Christopher Adlbrecht, MD, MBA l, Zygmunt P. Sadowski, MD e, Witold Ruzyllo, MD e, Debra J. Kinan, RT(N) a, Gervasio A. Lamas, MD m, Judith S. Hochman, MD bRésumé |
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.
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| Funding sources: OAT was supported by National Heart, Lung, and Blood Institute Awards U01HL062509 and U01HL062511; OAT-NUC was funded by National Institutes of Health Grant R01 HL075456—Myocardial Viability & Remodeling in the Occluded Artery Trial. Supplemental funding was received by Dr Camille A. Pearte, MD, between 2006 and 2008 by a Research Supplement (Grant No. R01 HL 075456-04S1) to Promote Diversity in Health-Related Research PA-05-015. Supplemental grant funds and product donations equivalent to 6% of total study costs were received from Eli Lilly, Millennium Pharmaceuticals and Schering Plough, Guidant, Cordis/Johnson and Johnson, Medtronic, Merck, and Bristol Myers Squibb Medical Imaging. |
Vol 161 - N° 3
P. 611-621 - mars 2011 Retour au numéro
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