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Many patients with ST-segment-elevation MI don’t receive coronary reperfusion therapy (fibrinolysis or percutaneous coronary intervention) because of late presentation. Data from observational studies suggest benefits of restoring myocardial flow more than 12 hours after symptom onset, when myocardial salvage is unlikely. Now, in a randomized trial called OAT (Occluded Artery Trial), researchers have compared optimal medical therapy alone with a strategy of late PCI (including stenting) plus optimal medical therapy in patients with persistent total occlusion after MI.
Subjects were 2166 stable patients with total occlusion of the infarct-related artery plus a left-ventricular ejection fraction <50% or proximal occlusion; all had angiography …