The secondary end points of death, recurrent MI, or stroke at 30 days occurred in 8 patients in the invasive group (4.4%) and 12 patients in the conservative group (6.6%) (relative risk, 0.67 95% CI, 0.27-1.62 P =. The mean difference in final left ventricular infarct size between the invasive and conservative groups was -6.8% (95% confidence interval, -10.2% to -3.5%). The final left ventricular infarct size was significantly smaller in patients assigned to the invasive group (median, 8.0% interquartile range, 2.0%-15.8%) vs those assigned to the conservative group (median, 13.0% IQR, 3.0%-27.0% P<.001). Secondary end points included composite of death, recurrent MI, or stroke at 30 days. The primary end point was final left ventricular infarct size according to single-photon emission computed tomography study with technetium Tc 99m sestamibi performed between 5 and 10 days after randomization in 347 patients (95.1%). Random assignment to either an invasive strategy (n=182) based predominantly on coronary stenting with abciximab or a conventional conservative treatment strategy (n=183). International, multicenter, open-label, randomized controlled trial conducted from May 23, 2001, to December 15, 2004, of 365 patients aged 18 to 80 years without persistent symptoms admitted with the diagnosis of acute STEMI between 12 and 48 hours after symptom onset. To assess whether an immediate invasive treatment strategy is associated with a reduction of infarct size in patients with acute STEMI, presenting between 12 and 48 hours after symptom onset, vs a conventional conservative strategy. Current guidelines do not recommend reperfusion treatment in these patients. No specifically designed studies have addressed the role of primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction (STEMI) presenting more than 12 hours after symptom onset.
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