Randomized trial of percutaneous coronary intervention for subacute infarct-related coronary artery occlusion to achieve long-term patency and improve ventricular function : The total occlusion study of Canada (TOSCA)-2 trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-12, Vol.114 (23), p.2449-2457
• Main Authors: DZAVIK, Vladimir, BULLER, Christopher E, THOMAS, Boban, BUSZMAN, Pawel, VOZZI, Carlos, GLANZ, Anthony, COHEN, Eric A, MECIAR, Peter, DEVLIN, Gerald, MASCETTE, Alice, SOPKO, George, KNATTERUD, Genell L, LAMAS, Gervasio A, HOCHMAN, Judith S, RANKIN, James M, MANCINI, G. B. John, CANTOR, Warren J, CARERE, Ronald J, ROSS, John R, ATCHISON, Deborah, FORMAN, Sandra
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Blood and lymphatic vessels; Canada; Cardiology. Vascular system; Cardiovascular system; Coronary Artery Disease - etiology; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; Disease Progression; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endpoint Determination; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Revascularization; Pharmacology. Drug treatments; Stents; Stroke Volume - physiology; Treatment Outcome; Vascular Patency - physiology; Vasodilator agents. Cerebral vasodilators; Ventricular Function, Left - physiology
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.669432

In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function. Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy-only patients had a patent IRA (P