- Question
- Does adding routine percutaneous coronary intervention (PCI) to optimal medical therapy reduce events in stable, high-risk patients with a persistently occluded infarct-related artery found after the usual window for myocardial salvage has passed?
- Design
- Randomized, unblinded study of 2166 stable patients; 1082 were assigned to PCI with stenting plus optimal medical therapy and 1084 to optimal medical therapy alone. The main follow-up reported was 4 years.
- Population
- Stable patients with total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction, meeting a high-risk criterion: ejection fraction below 50% or proximal occlusion.
- Intervention
- Routine PCI with stenting of the occluded artery, added to optimal medical therapy (aspirin, beta blockers, ACE inhibitors and risk factor modification).
- Control
- Optimal medical therapy alone, without revascularization of the occluded artery.
- Primary outcome
- Composite of death, myocardial reinfarction, or NYHA class IV heart failure.
- Results
- The 4-year cumulative primary event rate was 17.2% with PCI and 15.6% with medical therapy (HR 1.16; 95% CI 0.92 to 1.45; P=0.20). Reinfarction (fatal and nonfatal) occurred in 7.0% vs 5.3% (HR 1.36; 95% CI 0.92 to 2.00; P=0.13).
- Safety
- Only six reinfarctions (0.6%) were related to the assigned PCI procedures; there was a trend toward more nonfatal reinfarction with PCI (6.9% vs 5.0%; HR 1.44; 95% CI 0.96 to 2.16; P=0.08). NYHA class IV heart failure (4.4% vs 4.5%) and death (9.1% vs 9.4%) were similar.
- Conclusion
- PCI did not reduce death, reinfarction or heart failure, with a trend toward excess reinfarction over 4 years of follow-up in stable patients with an occluded infarct-related artery.
- Why it matters
- It showed that routinely opening a late, persistently occluded infarct artery in stable patients provides no clinical benefit over optimal medical therapy, and it changed practice regarding revascularization of these occlusions.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026