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Revascularization of AMI Patients Persists Despite No Demonstrated Benefit

Cheryl Clark, for HealthLeaders Media, July 13, 2011

In what was thought by some as a surprise, a large, federally funded randomized trial, Occluded Artery Trial (OAT) of 2006, found no benefit when patients had revascularization procedures more than 24 hours after their myocardial infarction, and when their conditions were considered stable.

Other reports estimated the cost of those procedures at about $7,000, Hochman said.

In 2007, the American College of Cardiology and the American Heart Association subsequently revised guidelines to reflect the new findings, saying that when patients with persistently occluded arteries are stable, and when their heart attacks occurred a day or more previously, revascularization "should not be performed."

The patients were stable, Hochman explained, because "Whatever heart muscle was still alive in the area of the blocked coronary was being supplied by other blood vessels through what we call collateral blood flow."

Hochman, Harold Snyder Family Professor of Cardiology at New York University Langone Medical Center, along with Marc. W. Deyell, MD, of the University of British Columbia in Vancouver, and others wanted to find out whether hospital teams have since changed their practice.

They examined data from the CathPCI Registry, which includes data from hospitals where cardiac catheterizations take place. In their study, they included 896 hospitals and 28,780 patient visits, between 2005 and 2008 and divided them into three groups, before the OAT results were published, between the OAT trial study publication and the issuance of guidelines, and after the guidelines.

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