The late open artery hypothesis—A decade later

• Published in: The American heart journal 2001-09, Vol.142 (3), p.411-421
• Main Authors: Sadanandan, Saihari, Buller, Christopher, Menon, Venu, Dzavik, Vladimir, Terrin, Michael, Thompson, Bruce, Lamas, Gervasio, Hochman, Judith S.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Clinical Trials as Topic; Coronary Disease - physiopathology; Coronary Disease - therapy; Coronary heart disease; Heart; Humans; Medical sciences; Myocardial Infarction - therapy; Myocardial Reperfusion; Practice Patterns, Physicians; Prevalence; Survival Analysis; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2001.117774

Background Early reperfusion after myocardial infarction has been proved to preserve left ventricular function and reduce mortality. However, a significant number of patients have persistent occlusion of the infarct-related artery late (days to weeks) after myocardial infarction because of ineligibility for thrombolytic therapy, failure of reperfusion, or reocclusion. Methods In this report we review the data on the potential mechanisms and benefits of late reperfusion and present prospective data on the incidence of and current practice patterns for the management of persistently occluded infarct-related arteries late after myocardial infarction. Results Although several studies have associated late patency of the infarct-related artery with improved long-term clinical outcome, they were nonrandomized and reflect selection bias. Furthermore, data on late patency from the largest study, Global Utilization of Steptokinase and Tissue Plasminogen Activator for Occluded Arteries (GUSTO-I), failed to confirm independent benefits of an open infarct-related artery 1 year after myocardial infarction. The randomized data on the effects of percutaneous transluminal coronary angioplasty for occluded infarct-related arteries late after myocardial infarction are limited and inconclusive. Conclusions The hypothesis that late reperfusion by percutaneous coronary intervention days to weeks after myocardial infarction results in improved long-term clinical outcomes in asymptomatic patients with occluded infarct-related artery is currently being tested in the randomized, multicenter Occluded Artery Trial. (Am Heart J 2001;142:411-21.)