VIAMI (Viability‐Guided Angioplasty after Acute Myocardial Infarction)

Presenter Gerrit Veen, MD, at the 2006 World Congress of Cardiology Background The viability of noncontracting myocardium can be assessed via dobutamine stimulation with cardiac ultrasound. Objective To prove (i) that when thrombolysis preserves viability in MI, PCI with stenting and abciximab (S + A) can prevent new MIs, and (ii) that without viability, re‐MI risk is low. Study Design Acute MI patients were stratified into viable and nonviable myocardium groups following low‐dose dobutamine echocardiography 48–72 h post MI. The viable group was randomized to an infarct‐related artery (IRA) S + A or to a conservative, ischemia‐guided strategy. The primary endpoints included (i) combined death, recurrent MI, and unstable angina, and (ii) the same components with the added element of elective revascularization. Study Population Among 216 patients in the viable group, the mean age was 60.5 years, and in the nonviable registry with 75 patients, it was 63.7 years. Results After 6 months, freedom from the primary endpoint was 93.5% in the invasive S + A group and 84.5% in the conservatively treated group (p = 0.04). For the further primary endpoint after adding elective revascularizations, the difference was greater (93.4% for the invasive group and 67.3% for the conservative group, p < 0.0001). The relative risk reduction for the invasive group was 82%. Among the endpoint components, the differences significantly favored the invasive strategy only for unstable angina, elective revascularizations and all revascularizations. Freedom from ischemia was more common (94.7%) in the nonviable group than in the conservatively treated viable group (85.5%, p < 0.05). Conclusions The strategy of early stenting of the IRA for patients with viability resulted in a clear reduction of ischemic events and a long‐term uneventful clinical course. Ischemic event incidence was low in the nonviable group. Viability testing should become a standard evaluation tool for patients in the early phase after thrombolysis or in acute MI without reperfusion therapy. In patients with viability, revascularization should be considered before hospital discharge.Copyright © 2006 Wiley Periodicals, Inc. Wiley Periodicals, Inc.