n Cardiovascular Journal of South Africa - The occluded coronary artery in the asymptomatic patient after myocardial infarction : should it be opened? : review article

Volume 13, Issue 3
  • ISSN : 1680-0745



This article reviews the evidence surrounding the 'open artery theory' : that the opening of an occluded artery in an asymptomatic patient after myocardial infarction confers survival benefits in excess of the amount of myocardium salvaged. Several mechanisms have been proposed in support of the theory, all of which remain unproven. The bulk of current knowledge about the open artery is drawn from observations on the spontaneous state of patency of the infarct-related artery and the results of ischaemia-driven intervention. The various studies indicate that the advantage of a patent infarctrelated artery is confined to groups of patients with left ventricular dysfunction or extensive (and particularly anterior) infarction. The largest database that examined the effect of the open artery did not find an independent association with survival a year after the infarct. In contrast, some smaller studies have reported deleterious effects from opening the occluded artery. The frequency of a totally occluded artery post-infarction, the lower rate of success in recanalising the vessel, and the high rate of reocclusion mediates against a policy of routinely opening the occluded vessel. The Occluded Artery Trial is comparing the outcomes in post-infarction patients with proximally occluded vessels that supply substantial amounts of myocardium randomised to either percutaneous recanalisation or medical therapy.

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