BackgroundDespiteobservationssuggestingabenefitforlateopeningoftotallyoccludedinfarct-relatedarteriesaftermyocardialinfarction,theOccludedArteryTrial(OAT)demonstratednoreductioninthecompositeofdeath,reinfarction,andclassIVheartfailureovera2.9-yearmeanfollow-up.Follow-upwasextendedtode-terminewhetherlatetrendswouldfavoreithertreatmentgroup.MethodsandResultsOATrandomized2201stablepatientswithinfarct-relatedarterytotalocclusion>24hours(calendardays3-28)aftermyocardialinfarction.Patientswithsevereinducibleischemia,restangina,classⅢ-Ⅳheartfailure,and3-vessel/leftmaindiseasewereexcluded.Weconductedextendedfollow-upofenrolledpatientsforanadditional3yearsfortheprimaryendpointandangina(6-yearmediansurvivorfollow-up;longest,9years;12234patient-years).Ratesoftheprimaryendpoint(hazardratio,1.06;95%confidenceinterval,0.88-1.28),fatalandnonfatalmyocardialinfarction(hazardratio,1.25;95%confidenceinterval,0.89-1.75),death,andclassIVheartfailureweresimilarforthepercutaneouscoronaryintervention(PCI)andmedicaltherapyalonegroups.Nointeractionsbetweenbaselinecharacteristicsandtreatmentgrouponoutcomeswereobserved.Thevastmajorityofpatientsateachfollow-upvisitdidnotreportangina.TherewaslessanginainthePCIgroupthroughearlyinfollow-up;by3years,thebetweengroupdifferencewasconsistently<4patientsper100treatedandnotsignificantlydifferent,althoughtherewasatrendtowardlessanginainthePCIgroupat3and5years.The7-yearrateofPCIoftheinfarct-relatedarteryduringfollow-upwas11.1%forthePCIgroupcomparedwith14.7%forthemedicaltherapyalonegroup(hazardratio,0.79;95%confidenceinterval,0.61-1.01;P=0.06).ConclusionsExtendedfollow-upoftheOATcohortprovidesrobustevidencefornoreductionoflong-termratesofclinicaleventsafterroutinePCIinstablepatientswithatotallyocclud
