CardioExchange Archive

Once again, a study finds that cardiologists don’t always pay attention to the literature and guidelines. In 2006, the Occluded Artery Trial (OAT) showed no benefit for routine PCI in patients with persistently occluded infarct-related arteries identified at least one day after an MI. But the study appears to have had minimal impact on clinical practice, according to a report published in the Archives of Internal Medicine.

To assess the impact of  OAT, Marc Deyell and colleagues used data from the CathPCI Registry to identify 28,780 patients treated from 2005 to 2008 who met the eligibility criteria for OAT. They found no significant decline in the rate of PCI in their population following the publication of OAT (OR 1.018; CI, 0.995-1.042). Following a subsequent revision of the guidelines (stating that PCI “should not be performed” in these patients), they detected a trend indicating fewer procedures (OR, 0.963;CI, 0.920-1.000). Overall, the crude rate of PCI for total occlusions was 54.2% before the publication of OAT, 52.8% after publication, and 51.9% after the guidelines were changed.

In their conclusion, the authors, led by Judith Hochman, write that the results are “a cause for concern on 2 levels. First, they imply that many stable patients with recent MI and persistent infarct artery occlusion continue to undergo a costly and ineffective procedure. Second, a large public, scientific, and human patient investment in the generation of robust clinical evidence has yet to broadly influence US practice.”

In an invited commentary, Mauro Moscucci writes that the reasons for the lack of response to OAT are “multifactorial.” He cites several potential factors affecting cardiologists, including “personal experience, a perception of low risk of PCI, a desire to please referring physicians, the feeling of a ‘mandate’ to relieve ischemia, the possibility of regret over the possible consequences of not intervening on a lesion, and patients’ expectations and anxiety.” Financial pressures may also come into play, he says.