The Occluded Artery Trial (OAT): Nuclear substudy

One of the greatest challenges in treating ST-segment elevation myocardial infarction (STEMI) is getting a patient reperfused quickly. Coronary artery reperfusion soon after coronary thrombosis interrupts a cascade of events leading to necrosis. Consequently, early reperfusion is associated with a reduction in infarct size, preservation of left ventricular (LV) function and geometry, and an improvement in both short- and long-term survival. However, between 15% and 30% of eligible patients do not receive early reperfusion therapy, in many cases because of late presentation. The accepted therapeutic window for reperfusion in uncomplicated acute myocardial infarction (AMI) is 12 hours after the onset of persistent symptoms, with the greatest benefit associated with intervention within the first hour or two post-infarction. The controversy has been how to manage patients presenting, late after STEMI. The 2004 guidelines endorsed aspirin and unfractionated heparin (UFH) therapy for STEMI patients either ineligible for reperfusion therapy or presenting too late (> 12 hours). As for invasive treatment, what about PCI in patients who did not undergo fibrinolysis?