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Clinical research

Causes of death in early MI survivors with persistent infarct artery occlusion: results from the Occluded Artery Trial (OAT)

1. Medical University of Vienna, Vienna, Austria; 2. Maryland Medical Research Institute, Baltimore, MD, USA; 3. Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy; 4. National Institute of Cardiology, Warsaw, Poland; 5. Cliniques Universitaires Saint-Luc, Brussels, Belgium; 6. Instituto De Intervenciones Cardiovasculares S.A., Rosario, Argentina; 7. INSERM U-698, Université Paris 7 and AP-HP, Paris, France; 8. Hospital Universitario Virgen de la Victoria de Málaga, Malaga, Spain; 9. Jan Pawel II Hospital, International Cardiology Clinic, Krakow, Poland; 10. National Heart, Lung, And Blood Institute, Bethesda, MD, USA; 11. Mount Sinai Medical Center, Miami Beach, FL, USA; 12. New York University School of Medicine, New York, NY, USA

Aims: OAT randomised patients with an occluded infarct artery three to 28 days after myocardial infarction (MI). The study demonstrated that PCI did not reduce the occurrence of the primary composite endpoint of death, re-MI, and New York Heart Association class IV heart failure in comparison with patients assigned to optimal medical therapy alone (MED). In view of prior literature in similar cohorts showing fewer sudden cardiac deaths and less left ventricular (LV) remodelling, but excess re-MI with PCI, causes of death were analysed in more detail.

Methods and results: Stepwise Cox regression was used to examine baseline variables associated with causes of death. The immediate and primary cause of death did not differ between 1,101 PCI and 1,100 MED patients. One-year cardiovascular death rates were 3.8% for the PCI group, and 3.7% for the MED group, and 0.9% per year for the next four years in both groups. Five of six cases of cardiac rupture occurred in patients undergoing PCI.

Conclusions: In stable post-MI patients with occlusion of the infarct-related artery, PCI did not change the rate or cause of death. The observation that the majority of cardiac ruptures occurred in patients undergoing PCI deserves further investigation.

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