Impact of Optimal Medical Therapy on Long-Term Outcomes After Myocardial Revascularization for Multivessel Coronary Disease.

Abstract

Although optimal medical therapy (OMT) after coronary revascularization is advocated for intensive secondary prevention, its criteria and effect on long-term outcomes are uncertain. Using data from the ASAN-Multivessel (Asan Medical Center-Multivessel Revascularization) registry, we identified 8,311 patients who underwent coronary artery bypass grafting (CABG) (n = 3,115) or percutaneous coronary intervention (PCI) (n = 5,196). OMT was defined as the combination of minimum of 3 medications in 4 drug classes (antiplatelet drugs, statins, β blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Two primary outcomes were all-cause mortality and serious composite outcome of death, spontaneous myocardial infarction, or stroke at 10 years. Of 8,311 patients, 4,321 (52.0%) followed OMT. In the 3,397 propensity-score-matched cohort, OMT status compared with non-OMT status was significantly associated with a lower risk of all-cause mortality (10.7% vs 18.7%; hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.47 to 0.65) and serious composite outcome (14.5% vs 22.5%, HR 0.635, 95% CI 0.55 to 0.73) at 10 years. The association on 10-year mortality was more prominent in the PCI group (HR 0.45, 95% CI 0.36 to 0.56) than in the CABG group (HR 0.72, 95% CI 0.58 to 0.90) with a significant interaction (p = 0.001). Overall findings were consistent using different OMT criteria (all 4 types of medications). In conclusion, OMT significantly lowered the risks of mortality and major cardiovascular events at 10 years in patients with multivessel revascularization. The OMT impact on mortality was more remarkable in the PCI group than in the CABG group. This work was registered at http://ClinicalTrials.gov (Identifier: NCT02039752).

• Authors: Jinsun Park, Se Hee Kim, Mijin Kim, Jinho Lee, Yeonwoo Choi, Hoyun Kim, Tae Oh Kim, Do-Yoon Kang, Jung-Min Ahn, Jae-Suk Yoo, Ho Jin Kim, Joon Bum Kim, Suk Jung Choo, Cheol-Hyun Chung, Seung-Jung Park, Duk-Woo Park, Asan-Multivessel Registry Investigators
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 203 Pg. 81-91 (09 15 2023) ISSN: 1879-1913 [Electronic] United States
• PMID: 37481816 (Publication Type: Clinical Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Topics

• Humans
• Coronary Artery Bypass (adverse effects)
• Coronary Artery Disease
• Myocardial Infarction (etiology)
• Myocardial Revascularization
• Percutaneous Coronary Intervention (adverse effects)
• Treatment Outcome