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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^*, Simon R. Redwood, MD, MRCP, FACC^*, Clifford A. Bucknall, MD, FRCP, Alfred N. Sulke, DM, MRCP, FACC and Michael S. Marber, PhD, FRCP, FACC^*,*

^* Department of Cardiology, Kings College London, London, United Kingdom
The Rayne InstituteLondon, United Kingdom
Guys and St Thomas’ Hospitals, London, United Kingdom
Department of Cardiology, Eastbourne District General Hospital, Eastbourne, United Kingdom

View larger version (22K): [in a new window]   Figure 1 The open artery trial protocol. *Two patients meeting the angiographic criteria were excluded on account of distal left anterior descending (LAD) occlusion with target vessel diameter <2.5 mm. Randomization was based on the principle of minimization of confounding baseline variables (see text). MI = myocardial infarction; PCI = percutaneous coronary intervention; TOAT = Open Artery Trial.

View larger version (17K): [in a new window]   Figure 2 Left ventricular size and function. Serial changes in left ventricular end-systolic volume, end-diastolic volume, and ejection fraction after myocardial infarction are shown with respect to patients randomized to the open artery group (open circles; n = 28) and to the closed artery group (open squares; n = 33).

View larger version (20K): [in a new window]   Figure 3 Exercise tolerance. Serial changes in maximal exercise duration (min) on the Bruce exercise protocol and peak rate-pressure product (product of heart rate and systolic blood pressure at point of peak exertion) after myocardial infarction are shown with respect to patients allocated to the open artery group (open circles; n = 26) and to the closed artery group (open squares; n = 27).

View larger version (28K): [in a new window]   Figure 4 Quality of life. Serial changes in quality of life scores (as assessed by the Nottingham Health Profile [NHP]) after myocardial infarction are shown. Higher scores reflect poorer quality of life. The NHP part I scores (reflecting self-perceived quality of life) are represented by open circles (n = 30) for open artery patients and open squares (n = 33) for closed artery patients. The NHP part II scores (reflecting overall impact on lifestyle) are represented by closed circles for open artery patients (n = 30) and closed squares (n = 33) for closed artery patients.