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OAT Trial Late CTO PCI — EECC MCQ

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ModerateGeneral CardiologyOAT Trial Late CTO PCIEECC

A 50-year-old man experiences an acute STEMI but presents 3 days late with completed infarction and no ongoing symptoms. Echocardiography shows akinesis of the anterior wall with LVEF 35%. Angiography shows a chronic total occlusion of the LAD. The OAT trial is discussed. What did it show?

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Correct answer: D — The OAT trial demonstrated no benefit from routine PCI of a totally occluded infarct-related artery >24 hours to 28 days after MI in stable, asymptomatic patients — medical therapy alone is appropriate

The OAT (Occluded Artery Trial, 2006) randomised 2,166 stable patients with a totally occluded infarct-related artery 3-28 days after MI (with no ongoing ischaemia) to PCI + stent vs medical therapy alone. Results: NO benefit from routine PCI for: death, reinfarction, or NYHA IV HF at 4-year follow-up. A non-significant trend toward increased reinfarction in the PCI group. The 2023 ESC ACS Guidelines therefore recommend AGAINST routine PCI of an occluded infarct artery in stable, asymptomatic patients >48 hours after STEMI (Class III). PCI IS still indicated for: (1) ongoing/recurrent ischaemia; (2) haemodynamic instability; (3) significant residual ischaemia on functional testing; (4) viable myocardium in the infarct territory with planned revascularisation for HF management.

Reference: ESC (2023): ACS Guidelines; OAT Trial