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Title: Infarct Artery Distribution and Clinical Outcomes in Occluded Artery Trial Subjects Presenting With Non ST-Segment Elevation Myocardial Infarction (from the Long-Term Follow-up of Occluded Artery Trial [OAT])
Authors: Menon, Venu
Ruzyllo, Witold
Carvalho, Antonio C. [UNIFESP]
Almeida de Sousa, Jose Marconi [UNIFESP]
Forman, Sandra A.
Jaworska, Krystyna
Lamas, Gervasio A.
Roik, Marek
Thuaire, Christophe
Turgeman, Yoav
Hochman, Judith S.
Cleveland Clin
Natl Inst Cardiol
Universidade Federal de São Paulo (UNIFESP)
Clin Trials & Surveys Corp
Reg Hosp
Columbia Univ
Med Univ Warsaw
Ctr Hop Louis Pasteur
Technion Israel Inst Technol
Issue Date: 1-Apr-2013
Publisher: Elsevier B.V.
Citation: American Journal of Cardiology. Bridgewater: Excerpta Medica Inc-Elsevier B.V., v. 111, n. 7, p. 930-935, 2013.
Abstract: We hypothesized that the insensitivity of the electrocardiogram. in identifying acute circumflex occlusion would result in differences in the distribution of the infarct-related artery (IRA) between patients with non ST-segment elevation myocardial infarction (NSTEMI) and STEMI enrolled in the Occluded Artery Trial. We also sought to evaluate the effect of percutaneous coronary intervention to the IRA on the clinical outcomes for patients with NSTEMI. Overall, those with NSTEMI constituted 13% (n = 283) of the trial population. the circumflex IRA was overrepresented in the NSTEMI group compared to the STEM! group (42.5 vs 11.2%; p < 0.0001). the 7-year clinical outcomes for the patients with NSTEMI randomized to percutaneous coronary intervention and optimal medical therapy versus optimal medical therapy alone were similar for the primary composite of death, myocardial infarction, and class W congestive heart failure (22.3% vs 20.2%, hazard ratio 1.20, 99% confidence interval 0.60 to 2.40; p = 0.51) and the individual end points of death (13.8% vs 17.0%, hazard ratio 0.82, 99% confidence interval 0.37 to 1.84; p = 0.53), myocardial infarction (6.1 vs 5.1%, hazard ratio 1.11, 99% confidence interval 0.28 to 4.41; p = 0.84), and class IV congestive heart failure (6.7% vs 6.0%, hazard ratio 1.50, 99% confidence interval 0.37 to 6.02; p = 0.45). No interaction was seen between the electro-cardiographically determined myocardial infarction type and treatment effect (p = NS). in conclusion, the occluded circumflex IRA is overrepresented in the NSTEMI population. Consistent with the overall trial results, stable patients with NSTEMI and a totally occluded IRA did not benefit from randomization to percutaneous coronary intervention. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:930-935)
ISSN: 0002-9149
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