In high-risk patients, optimal medical therapy confers survival benefit after PCI, CABG
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At 10 years, patients with three-vessel or left main disease who underwent PCI or CABG were more likely to survive if they were taking optimal medical therapy at 5 years, researchers reported.
The researchers analyzed 1,472 patients (mean age, 64 years; 79% men) from the SYNTAXES extended study of participants from the SYNTAX trial.
Participants were stratified by whether they were on optimal medical therapy at 5 years. Optimal medical therapy was defined as the combination of four types of medications: at least one antiplatelet drug, a statin, an ACE inhibitor or angiotensin receptor blocker and a beta-blocker.
The primary outcome of mortality at 10 years was lower in those who were on optimal medical therapy at 5 years compared with those who were on two or fewer of the four classes of medications (13.1% vs. 19.9%; adjusted HR = 0.47; 95% CI, 0.292-0.757; P = .002), Hideyuki Kawashima, MD, from National University of Ireland Galway, and colleagues wrote.
There was no difference in 10-year mortality between those on all four classes of medications and those on three classes of medications (four, 13.1%; three, 12.7%; aHR = 0.953; 95% CI, 0.617-1.473; P = .83), according to the researchers.
Among patients who had CABG, those who were on antiplatelet drugs and statins at 5 years had lower mortality at 10 years than those who were not (aHR for antiplatelets = 0.283; 95% CI, 0.137-0.585; P = .001; aHR for statins = 0.246; 95% CI, 0.123-0.493; P < .001), the researchers wrote.
“These findings suggest the importance of maintenance optimal medical therapy over the long term in extending life span after coronary revascularization,” Kawashima and colleagues wrote.
In a related editorial, William E. Boden, MD, professor of medicine at the Boston University School of Medicine, lecturer in medicine at Harvard Medical School and physician research lead and scientific director of the Clinical Trials Network of the VA New England Healthcare System in Boston, and Cardiology Today Editorial Board Member Bernard J. Gersh, MB, ChB, DPhil, emeritus professor of medicine at Mayo Clinic in Rochester, Minnesota, wrote, “These observations are extremely important in reaffirming the synergistic and beneficial effect of optimal medical therapy on long-term mortality in patients undergoing revascularization with either CABG or PCI.”
They noted that optimal medical therapy usage is “unacceptably low in the U.S. and globally” and thus “optimal medical therapy usage among patients undergoing revascularization should be considered an imperative to optimize clinical outcomes and reduce incident cardiovascular events during long-term follow-up.”
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