Late opening of occluded coronary artery in myocardial infarction patients: is it always advisable?

Abstract

Aim. The study was aimed at verifying a hypothesis: in myocardial infarction (MI) patients with occluded MI‑related coronary artery (IMCA), routine percutaneous coronary intervention is more effective than conservative, pharmacological treatment, for reducing cumulative total mortality risk, risk of recurrent non‑fatal MI, or severe heart failure (HF).
Material and methods. The study included 2166 MI patients, with stable clinical course and IMCA occlusion remaining at Day 3‑28, verified by coronary angiography. The participants were randomized into two groups: pharmaceutical treatment group (n=1084) and invasive treatment group (n=1082). Combined primary end‑point included death due to all causes; non‑fatal MI; severe HF with hospitalization. Secondary end‑points were separate components of primary end‑point.
Results. By the end of follow‑up Year 4, primary end‑point rates were 17,2% and 15,6% in invasive and pharmaceutical treatment groups, respectively (р=0,2). No benefits for any strategy were observed in various subgroups by age, gender, ethnicity, coronary occlusion localization, left ventricular contractility, diabetes mellitus, severity and duration of the disease. Total mortality was identical in both groups. Recurrent MI rates were higher in invasive therapy group, compared to pharmaceutical therapy group.
Conclusion. Therefore, late opening of occluded IMCA in stable patients did not reduce the risk of death, recurrent IM, or severe HF during four‑year follow‑up.