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Adherence to medication linked to higher event-free survival rate after revascularization
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Patients following a prescribed medication regimen after PCI or CABG were more than twice as likely to experience event-free survival than those nonadherent to their medications, according to new data published in Circulation.
“Adherence can have a dramatic impact on the long-term outcome of both heart bypass and angioplasty patients, and that impact may be more compelling in angioplasty than in bypass patients,” Paul Kurlansky, MD, assistant professor of surgery at Columbia University Medical Center and cardiac surgeon at NewYork-Presbyterian/Columbia University Medical Center, said in a press release.
The researchers analyzed the impact of medication adherence on long-term outcomes in 973 patients who underwent CABG and 2,355 patients who underwent PCI from February to July 2004 and were followed for up to 8 years.
The outcomes of interest were all-cause mortality, nonfatal MI and reintervention. Those who underwent CABG were compared with those who underwent PCI via propensity score matching.
In both the CABG group and the PCI group, antiplatelet, lipid-lowering and beta-blocker therapies were associated with improved event-free survival (P = .001 for all), according to the researchers.
However, compliance with optimal medical therapy was a more powerful predictor of MACE-free survival than choice of therapy (HR for noncompliance = 2.79; 95% CI, 2.19-3.54; HR for PCI vs. CABG = 1.68, 95% CI, 1.38-2.04).
In the propensity-matched cohort, those who had CABG had superior outcomes to those who had PCI outcomes among patients nonadherent to optimal medical therapy (P = .001), but this was not true among patients adherent to optimal medical therapy (P = .574), Kurlansky and colleagues wrote.
According to the researchers, medication adherence likely affects clinical decision making and should be incorporated into future studies comparing strategies for coronary revascularization.
“We know enough from this study to seriously ask the question — are patients unwilling to adhere to medication schedules better off choosing heart bypass over angioplasty — but the answer needs to come from larger, more contemporary trials,” Kurlansky said in the release. – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.
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