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J Am Coll Cardiol, 2002; 40:869-876
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: PERCUTANEOUS CORONARY INTERVENTION

Late intervention after anterior myocardial infarction: effects on left ventricular size, function, quality of life, and exercise tolerance

Results of the Open Artery Trial (TOAT Study)

Zaheer R. Yousef, BSc, MRCP*{dagger}{ddagger}, Simon R. Redwood, MD, MRCP, FACC*{dagger}{ddagger}, Clifford A. Bucknall, MD, FRCP{ddagger}, Alfred N. Sulke, DM, MRCP, FACC§ and Michael S. Marber, PhD, FRCP, FACC*{dagger}{ddagger},*

* Department of Cardiology, Kings College London, London, United Kingdom
{dagger} The Rayne InstituteLondon, United Kingdom
{ddagger} Guys and St Thomas’ Hospitals, London, United Kingdom
§ Department of Cardiology, Eastbourne District General Hospital, Eastbourne, United Kingdom

Manuscript received December 10, 2001; revised manuscript received May 2, 2002, accepted May 24, 2002.

* Reprint requests and correspondence: Dr. Michael S. Marber, Department of Cardiology, KCL, The Rayne Institute, St. Thomas’ Hospital, London SE1 7EH, UK.
mike.marber{at}kcl.ac.uk

OBJECTIVE: We sought to conduct a randomized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infarction (AMI).

BACKGROUND: In the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that an open infarct related artery benefits healing post AMI.

METHODS: Of 223 patients enrolled with Q-wave anterior AMI, 66 with isolated persistent occlusion of the left anterior descending coronary artery (LAD) were randomized to the following treatments: 1) medical therapy (closed artery group; n = 34) or 2) late intervention and stent to the LAD + medical therapy (open artery group; n = 32). The study was powered to compare left ventricular (LV) end-systolic volume between the two groups 12 months post AMI.

RESULTS: Late intervention 26 ± 18 days post AMI resulted in significantly greater LV end-systolic and end-diastolic volumes at 12 months than medical therapy alone (106.6 ± 37.5 ml vs. 79.7 ± 34.4 ml, p < 0.01 and 162.0 ± 51.4 ml vs. 130.1 ± 46.1 ml, p < 0.01, respectively). Exercise duration and peak workload significantly increased in both groups from 6 weeks to 12 months post AMI, although absolute values were greater in the open artery group. Quality of life scores tended to deteriorate during this time interval in the closed artery patients but remained unchanged in the open artery patients. Coronary angiography at 1 year documented a low incidence of intergroup cross-over (spontaneous recanalization in 19% and closure in 11%).

CONCLUSIONS: In the present study, recanalization of occluded infarct-related arteries in symptom-free patients approximately 1 month post AMI had an adverse effect on remodeling but tended to increase exercise tolerance and improve quality of life.

Abbreviations and Acronyms
  ACE-I
  angiotensin-converting enzyme inhibitor
  EDV
  end-diastolic volume
  EF
  ejection fraction
  ESV
  end-systolic volume
  LAD
  left anterior descending
  LV
  left ventricle/ventricular
  MI
  myocardial infarction
  NHP
  Nottingham Health Profile
  PCI
  percutaneous coronary intervention
  QoL
  quality of life
  TAMI
  Thrombolysis and Angioplasty in Myocardial Infarction trial
  TIMI
  Thrombolysis In Myocardial Infarction




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