725-1 Long-term Impact of a Patent Infarct-related Artery: 1-Year Survival In the GUSTO Trial

Abstract

The “open-artery” hypothesis has been validated in the acute phase of coronary occlusion. Controversy remains regarding long-term survival and the need for revascularization. To examine the long-term impact of a patent infarct-related artery in the GUSTO trial, we evaluated prospectively collected data on 41,021 patients treated with thrombolytic therapy for acute infarction. Patency data were available in 12,864 patients undergoing their first post-infarction angiogram who had no prior history of PTCA or CABG and who were not enrolled in the angiographic substudy. The infarct-related artery was open in 8,810 and closed in 4,054 patients. In the open artery cohort, 50% were treated medically, 38% with PTCA, and 12% with CABG. The corresponding percentages in the closed artery cohort were 45, 41 and 14, respectively. Baseline demographics, risk factor profiles, extent of disease and time to treatment were similar for both groups. Patients with a closed artery had a slightly higher incidence of Killip Class III and IV than the open artery cohort (2% vs 1%). As expected, patients treated medically and with PTCA in both groups had a preponderance of 1 and 2 vessel disease and patients treated with CABG had a preponderance of 2 and 3 vessel disease. 1-Year Mortality Open Artery Closed Artery P-value - Medical Therapy (%) 3.3 8.5 <0.001 - PTCA(%) 2.5 88 <0.001 - CABG(%) 4.2 9.6 <0.001 Infarct-related artery patency confers a survival advantage at 1-year across all thrombolytic treatment strategies in patients with acute myocardial infarction.