Late PCI After Myocardial Infarction in Stable Patients — Where’s the Benefit?

A large randomized trial suggests that medical therapy may be as beneficial as PCI in these patients.

Early revascularization during an acute ST-segment elevation myocardial infarction enhances myocardial salvage and improves short-term outcomes. However, data also suggest that an open infarct-related artery improves longer term survival, perhaps by reducing risk for arrhythmia and sudden death. This “open-artery hypothesis” has led to the practice of opening occluded infarct-related arteries, even days or weeks after the MI, when myocardial salvage is unlikely.

In a large international trial of late revascularization, investigators randomized 2166 stable patients — all of whom had total occlusion of the infarct-related artery 3 to 28 days after MI, and an ejection fraction of <50% or a proximal occlusion of a major vessel supplying a large …

Reviewing Author

Kirsten E. Fleischmann, MD, MPH