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

被引：26

作者：

Udelson, James E. ^{[1
]}

Pearte, Camille A. ^{[2
]}

Kimmelstiel, Carey D. ^{[1
]}

Kruk, Mariusz ^{[5
]}

Kufera, Joseph A. ^{[3
]}

Forman, Sandra A. ^{[4
]}

Teresinska, Anna ^{[5
]}

Bychowiec, Bartosz ^{[6
]}

Marin-Neto, Jose Antonio ^{[7
]}

Hoechtl, Thomas ^{[8
]}

Cohen, Eric A. ^{[9
]}

Caramori, Paulo ^{[10
]}

Busz-Papiez, Benita ^{[11
]}

Adlbrecht, Christopher ^{[12
]}

Sadowski, Zygmunt P. ^{[5
]}

Ruzyllo, Witold ^{[5
]}

Kinan, Debra J. ^{[1
]}

Lamas, Gervasio A. ^{[13
]}

Hochman, Judith S. ^{[2
]}

机构：

[1] Tufts Med Ctr, Boston, MA 02111 USA

[2] NYU, Sch Med, New York, NY USA

[3] Kufera Consulting Inc, Monkton, MD USA

[4] Clin Trials & Surveys Corp, Owings Mills, MD USA

[5] Natl Inst Cardiol, Warsaw, Poland

[6] Karol Marcinkowski Univ Med Sci, Poznan, Poland

[7] USP, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, Brazil

[8] Wilhelminenhosp, Vienna, Austria

[9] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[10] Pontificia Univ Catolica Rio Grande do Sul, Hosp Sao Lucas, Porto Alegre, RS, Brazil

[11] SP Wojewodzki Szpital Zespolony & Szczecinie, Szczecin, Poland

[12] Med Univ Vienna, Vienna, Austria

[13] Columbia Univ, Div Cardiol, Mt Sinai Med Ctr, Miami Beach, FL USA

来源：

AMERICAN HEART JOURNAL | 2011年 / 161卷 / 03期

基金：

美国国家卫生研究院;

关键词：

ACUTE MYOCARDIAL-INFARCTION; GATED SPECT; REVASCULARIZATION; DYSFUNCTION; VOLUMES; SIZE; TC-99M-SESTAMIBI; METAANALYSIS; ANGIOPLASTY; OCCLUSION;

D O I：

10.1016/j.ahj.2010.11.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (Am Heart J 2011; 161: 611-21.)

引用

页码：611 / 621

页数：11

共 29 条

[1] Survival and cardiac remodeling benefits in patients undergoing late percutaneous coronary intervention of the infarct-related artery: Evidence from a meta-analysis of randomized controlled trials [J].