Registry data show that the rate of late PCI on completely occluded arteries did not decline after the OAT findings prompted guideline recommendations against it.

The 2006 Occluded Artery Trial (OAT) demonstrated no benefit of percutaneous coronary intervention (PCI) to treat completely occluded culprit arteries >24 hours after acute myocardial infarction (MI; JW Cardiol Nov 14 2006).

Consequently, the 2007 American College of Cardiology/American Heart Association guidelines for ST-segment-elevation MI (STEMI), non-STEMI, and PCI include class III recommendations against such treatment. To what extent have the OAT results and the guideline recommendations been incorporated into practice?


Using National Cardiovascular Data Registry (CathPCI) data, investigators identified 28,780 patients with at least one total coronary occlusion and no reported OAT exclusion characteristics who underwent angiography >24 hours after the onset of MI symptoms. Because the registry does not specify whether treated occlusions were in infarct-related arteries, the investigators excluded lesions treated with prior coronary artery bypass grafting. Furthermore, because diagnostic angiography without PCI is not necessarily included in the registry, a secondary analysis was confined to centers reporting ?3 times as many diagnostic angiograms as PCIs. Three periods were compared: prior to OAT publication (2005–2006), after OAT publication but before the guideline revisions (2006–2007), and after the guideline revisions (2007–2008).

The patient populations differed only modestly among the three periods. Overall, 53% of patients with qualifying total coronary occlusions underwent PCI; this rate did not differ significantly among the three periods. The findings were similar in an analysis restricted to patients with STEMI. In centers reporting high rates of diagnostic angiography, the rate of PCI for total occlusions declined from 42.4% to 38.5% after the guideline revisions, a marginally significant difference after adjustment for patient characteristics (odds ratio, 0.963).


Citation(s):

Deyell MW et al. Impact of national clinical guideline recommendations for revascularization of persistently occluded infarct-related arteries on clinical practice in the United States. Arch Intern Med 2011 Jul 11; [e-pub ahead of print].

Moscucci M. Medical reversal, clinical trials, and the "late" open artery hypothesis in acute myocardial infarction. Arch Intern Med 2011 Jul 11; [e-pub ahead of print].