Brigitta C. Brott, MD; William B. Hillegass, MD, MPH
In stable patients presenting > 12 h after acute myocardial infarction (AMI), is percutaneous coronary intervention (PCI) of the infarct-related artery (IRA) more effective than optimal medical management alone?
Studies selected compared late PCI of the IRA plus medical therapy with optimal medical therapy alone in hemodynamically stable patients enrolled > 12 h after onset of symptoms of AMI. Studies enrolling patients with indications for urgent PCI were excluded. Outcomes were death; death or nonfatal AMI; death, nonfatal AMI, or hospitalization for angina or heart failure; nonfatal AMI; and change in left ventricular ejection fraction (LVEF).
PubMed, Cochrane Central Register of Controlled Trials, mRCT, BioMedCentral, Cardiosource, www.clinicaltrials.gov, and ISI Web of Science (to Jul 2007); and proceedings from major cardiology meetings (2004 to 2007) were searched for randomized controlled trials. Experts were consulted. 10 RCTs (n = 3560, mean age 59 y, 77% men) met the selection criteria. Median time from AMI to intervention ranged from 1 to 32 d (mean 12 d), and median follow-up ranged from 3 mo to 10 y (mean 2.8 y).
PCI reduced risk for death more than medical therapy, but groups did not differ for other clinical outcomes (Table). PCI resulted in greater improvement in LVEF (weighted mean difference 4.4%, 95% CI 1.1 to 7.6; 7 RCTs, n = 2829). Meta-regression analysis suggested greater benefit of PCI in trials with less strict angiographic criteria (that included patients with both total and subtotal occlusions), that did not exclude patients with ischemia, and that had longer follow-up.
In stable patients presenting > 12 h after acute myocardial infarction, percutaneous coronary intervention of the infarct-related artery improves survival more than optimal medical management alone.
Percutaneous coronary intervention (PCI) vs optimal medical therapy for stable patients presenting > 12 h after acute myocardial infarction (AMI)*
*Abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a random-effects model.
Brott BC, Hillegass WB. Review: Late percutaneous coronary intervention after AMI improves survival more than optimal medical therapy. Ann Intern Med. ;149:JC1–6. doi: 10.7326/0003-4819-149-2-200807150-02006
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Published: Ann Intern Med. 2008;149(2):JC1-6.
Cardiology, Coronary Heart Disease, Percutaneous Coronary Intervention.
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