Author Affiliations: Cardiovascular Clinical Research Center, New York University School of Medicine, New York (Dr Hochman); and Division of Cardiology, St Michael's Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Buller).
We agree with Appleton et al that “Patients who present late with an acute MI are a heterogeneous population”; the OAT results do not apply to all. It is precisely this heterogeneity that makes conclusions from the meta-analysis by Abbate et al1 invalid. That analysis did not restrict itself to patients with total occlusions late after MI, but rather included patients with closed and patent IRAs.2 The meta-analysis that restricted itself to post-MI patients with total IRA occlusion showed no benefit from routine PCI.3 It is this subset to which the updated guideline recommendation applies.
Hochman JS, Buller CE. Percutaneous Coronary Intervention for Persistent Occlusion of the Infarct-Related Artery: An Expanded View of the Evidence—Reply. Arch Intern Med. 2011;171(21):1962-1963. doi:10.1001/archinternmed.2011.552