Medical therapy

In high-risk patients, optimal medical therapy confers a survival benefit after PCI, CABG


Disclosures: Boden, Gersh and Kawashima do not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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At 10 years, patients with tri-vessel or left main disease who underwent PCI or CABG were more likely to survive if they were on optimal medical treatment at 5 years, the researchers reported.

The researchers analyzed 1,472 patients (mean age, 64 years; 79% male) from the extended SYNTAXES study of participants in the SYNTAX trial.

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Participants were stratified by whether or not they were on optimal medical treatment at 5 years. The optimal medical treatment has been defined as the combination of four types of drugs: at least one antiplatelet agent, a statin, an ACE inhibitor or an angiotensin receptor antagonist and a beta-blocker.

The primary endpoint of 10-year mortality was lower in those on optimal medical therapy at 5 years compared to those taking two or fewer of the four drug classes (13.1% versus 19.9%; adjusted RR = 0.47, 95% CI, 0.292-0.757; P = .002), Hideyuki Kawashima, MD, from the National University of Ireland at Galway, and his colleagues wrote.

There was no difference in 10-year mortality between people taking all four drug classes and those taking all three drug classes (four, 13.1%; three, 12.7%; aHR = 0.953; CI at 95%, 0.617-1.473; P = .83), according to the researchers.

Among patients who underwent CABG, those taking antiplatelet drugs and statins at 5 years had lower mortality at 10 years than those who did not (aHR for antiplatelets = 0.283; 95% CI, 0.137 -0.585; P = 0.001; aHR for statins = 0.246; 95% CI, 0.123-0.493; P

“These findings suggest the importance of maintaining optimal long-term medical therapy to prolong life after coronary revascularization,” Kawashima and colleagues wrote.

William E. Boden

Bernard J. Gersh

In a related editorial, William E. Boden, MD, Professor of Medicine at Boston University School of Medicine, Lecturer in Medicine at Harvard Medical School, and Chief Research Physician and Scientific Director of the Clinical Trials Network at the VA New England Healthcare System in Boston, and cardiology today Member of the editorial board Bernard J. Gersh, MB, ChB, DPhil, Professor Emeritus of Medicine at the Mayo Clinic in Rochester, Minnesota, wrote, “These observations are extremely important in reaffirming the synergistic and beneficial effect of optimal medical treatment on long-term mortality in patients undergoing revascularization with CABG. or ICP.

They noted that the optimal use of medical therapy is “unacceptably low in the United States and globally” and therefore “optimal use of medical therapy in patients undergoing revascularization should be considered imperative to optimize clinical outcomes and reduce incident cardiovascular events during long-term follow-up.”