Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT)

Christopher B. Overgaard, Vladimír Džavík, Christopher E. Buller, Li Liu, Waldemar Banasiak, Gerard Devlin, Aldo P. Maggioni, Jonathan Leor, Jeffery R. Burton, Gilmar Reis, Witold Ruzyllo, Sandra A. Forman, Gervasio A. Lamas, Judith S. Hochman

Research output: Contribution to journalArticlepeer-review

Abstract

Background Percutaneous coronary intervention (PCI) of a persistently totally occluded infarct-related artery (IRA) in stable high-risk patients > 24 h after myocardial infarction (MI) does not reduce the occurrence of death, re-infarction, or heart failure. Diabetic patients are at higher risk for cardiovascular events; we examined their outcomes overall with PCI and optimal medical therapy alone (MED). Methods The long-term (7-year) outcomes of 454 diabetic patients (20.6%) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy. Results The 7-year cumulative primary event rate for diabetic patients was 35.0% vs. 19.4% in the non-diabetic cohort (p < 0.001). Multivariable analyses revealed diabetes to be an independent predictor (p < 0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3% in the PCI group vs. 34.5% in the medical therapy group in diabetic patients (p = 0.19) and 19.3% in the PCI group vs. 19.5% in the medical therapy group in patients without diabetes (p = 0.60). Conclusions Despite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI.

Original languageEnglish
Pages (from-to)2416-2422
Number of pages7
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
StatePublished - 3 Oct 2013

Keywords

  • Diabetes
  • Occluded artery
  • Open artery hypothesis
  • Percutaneous coronary intervention

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