Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial)
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Outros Autores: | , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://repositorio.unifesp.br/handle/11600/34630 http://dx.doi.org/10.1016/j.amjcard.2011.10.015 |
Resumo: | Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. the primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged <= 65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). the 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). the rate of early. PCI complications was low in the 2 age groups. the trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. in conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:614-619) |
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Skolnick, Adam H.Reynolds, Harmony R.White, Harvey D.Menon, VenuCarvalho, Antonio C. [UNIFESP]Maggioni, Aldo P.Pearte, Camille A.Gruberg, LuisAzevedo, Rudyney E. U. [UNIFESP]Schroeder, ErwinForman, Sandra A.Lamas, Gervasio A.Hochman, Judith S.Dzavik, VladimirNYU Med CtrGreen Lane Cardiovasc ServCleveland ClinUniversidade Federal de São Paulo (UNIFESP)Italian Assoc Hosp CardiolSUNY Stony BrookClin Univ UCL Mont GodinneClin Trials & Surveys CorpMount Sinai Med CtrUniv Hlth Network2016-01-24T14:17:55Z2016-01-24T14:17:55Z2012-03-01American Journal of Cardiology. Bridgewater: Excerpta Medica Inc-Elsevier B.V., v. 109, n. 5, p. 614-619, 2012.0002-9149http://repositorio.unifesp.br/handle/11600/34630http://dx.doi.org/10.1016/j.amjcard.2011.10.01510.1016/j.amjcard.2011.10.015WOS:000301394200003Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. the primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged <= 65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). the 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). the rate of early. PCI complications was low in the 2 age groups. the trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. in conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:614-619)National Heart, Lung, and Blood Institute, Bethesda, MarylandNYU Med Ctr, Leon H Charney Div Cardiol, New York, NY 10016 USAGreen Lane Cardiovasc Serv, Auckland, New ZealandCleveland Clin, Cleveland, OH 44106 USAHosp São Paulo, Moema, SP, BrazilItalian Assoc Hosp Cardiol, Res Ctr, Florence, ItalySUNY Stony Brook, Med Ctr, Stony Brook, NY 11794 USAUniversidade Federal de São Paulo, São Paulo, BrazilClin Univ UCL Mont Godinne, Yvoir, BelgiumClin Trials & Surveys Corp, Owings Mills, MD USAMount Sinai Med Ctr, Miami Beach, FL USAUniv Hlth Network, Peter Munk Cardiac Ctr, Toronto, ON, CanadaHosp São Paulo, Moema, SP, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilNational Heart, Lung, and Blood Institute, Bethesda, Maryland: U01 HL062509National Heart, Lung, and Blood Institute, Bethesda, Maryland: U01 HL062511Web of Science614-619engElsevier B.V.American Journal of Cardiologyhttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policyinfo:eu-repo/semantics/openAccessComparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial)info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlereponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/346302023-02-15 09:10:16.529metadata only accessoai:repositorio.unifesp.br:11600/34630Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-02-15T12:10:16Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.en.fl_str_mv |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
title |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
spellingShingle |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) Skolnick, Adam H. |
title_short |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
title_full |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
title_fullStr |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
title_full_unstemmed |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
title_sort |
Comparison of Late Results of Percutaneous Coronary Intervention Among Stable Patients <= 65 Versus > 65 Years of Age With an Occluded Infarct Related Artery (from the Occluded Artery Trial) |
author |
Skolnick, Adam H. |
author_facet |
Skolnick, Adam H. Reynolds, Harmony R. White, Harvey D. Menon, Venu Carvalho, Antonio C. [UNIFESP] Maggioni, Aldo P. Pearte, Camille A. Gruberg, Luis Azevedo, Rudyney E. U. [UNIFESP] Schroeder, Erwin Forman, Sandra A. Lamas, Gervasio A. Hochman, Judith S. Dzavik, Vladimir |
author_role |
author |
author2 |
Reynolds, Harmony R. White, Harvey D. Menon, Venu Carvalho, Antonio C. [UNIFESP] Maggioni, Aldo P. Pearte, Camille A. Gruberg, Luis Azevedo, Rudyney E. U. [UNIFESP] Schroeder, Erwin Forman, Sandra A. Lamas, Gervasio A. Hochman, Judith S. Dzavik, Vladimir |
author2_role |
author author author author author author author author author author author author author |
dc.contributor.institution.none.fl_str_mv |
NYU Med Ctr Green Lane Cardiovasc Serv Cleveland Clin Universidade Federal de São Paulo (UNIFESP) Italian Assoc Hosp Cardiol SUNY Stony Brook Clin Univ UCL Mont Godinne Clin Trials & Surveys Corp Mount Sinai Med Ctr Univ Hlth Network |
dc.contributor.author.fl_str_mv |
Skolnick, Adam H. Reynolds, Harmony R. White, Harvey D. Menon, Venu Carvalho, Antonio C. [UNIFESP] Maggioni, Aldo P. Pearte, Camille A. Gruberg, Luis Azevedo, Rudyney E. U. [UNIFESP] Schroeder, Erwin Forman, Sandra A. Lamas, Gervasio A. Hochman, Judith S. Dzavik, Vladimir |
description |
Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. the primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged <= 65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). the 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). the rate of early. PCI complications was low in the 2 age groups. the trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. in conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:614-619) |
publishDate |
2012 |
dc.date.issued.fl_str_mv |
2012-03-01 |
dc.date.accessioned.fl_str_mv |
2016-01-24T14:17:55Z |
dc.date.available.fl_str_mv |
2016-01-24T14:17:55Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
American Journal of Cardiology. Bridgewater: Excerpta Medica Inc-Elsevier B.V., v. 109, n. 5, p. 614-619, 2012. |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/34630 http://dx.doi.org/10.1016/j.amjcard.2011.10.015 |
dc.identifier.issn.none.fl_str_mv |
0002-9149 |
dc.identifier.doi.none.fl_str_mv |
10.1016/j.amjcard.2011.10.015 |
dc.identifier.wos.none.fl_str_mv |
WOS:000301394200003 |
identifier_str_mv |
American Journal of Cardiology. Bridgewater: Excerpta Medica Inc-Elsevier B.V., v. 109, n. 5, p. 614-619, 2012. 0002-9149 10.1016/j.amjcard.2011.10.015 WOS:000301394200003 |
url |
http://repositorio.unifesp.br/handle/11600/34630 http://dx.doi.org/10.1016/j.amjcard.2011.10.015 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
American Journal of Cardiology |
dc.rights.driver.fl_str_mv |
http://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
614-619 |
dc.publisher.none.fl_str_mv |
Elsevier B.V. |
publisher.none.fl_str_mv |
Elsevier B.V. |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
|
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1802764191164006400 |