Association of guideline-directed medical therapy adherence with outcomes after fractional flow reserve-based deferral of revascularization

Abstract

Aims Guideline-directed medical therapy (GDMT) is essential to prevent future cardiovascular events in chronic coronary syndrome (CCS) patients. However, whether achieving optimal GDMT could improve clinical outcomes in CCS patients with deferred lesions based on fraction flow reserve (FFR) remains thoroughly investigated. We sought to evaluate the association of GDMT adherence with long-term outcomes after FFR-based deferral of revascularization in a real-world registry. Methods and Results This is a post hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicenter registry). Optimal GDMT was defined as combining 4 types of medications: antiplatelet drug, angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker, beta-blocker, and statin. After stratifying patients by the number of individual GDMT agents at 2 years, landmark analysis was conducted to assess the relationship between GDMT adherence at 2 years and 5-year major adverse cardiac events (MACE), defined as a composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization. Compared with the suboptimal GDMT group (continuing ≤3 types of medications, n = 974), the optimal GDMT group (n = 139) showed a lower 5-year incidence of MACE (5.2% vs. 12.4%, p = 0.02). The optimal GDMT was associated with a lower risk of MACE (hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.92; p = 0.03). Conclusion Patients with optimal GDMT were associated with better outcomes, suggesting the importance of achieving optimal GDMT on long-term prognosis in CCS patients after FFR-guided deferral of revascularization.

Prognostic Impact of Renal Function on 5‐Year Outcomes After Fractional Flow Reserve‐Guided Deferral of Revascularization

“…Seventh, the optimal medical therapy is mandatory to prevent future events in deferred lesions. Although statin use was reportedly associated with a lower incidence of cardiac death after deferring revascularization based on FFR in patients with chronic coronary syndrome, 18 it was less frequently used in the ESRD group than in other groups, potentially leading to worse outcomes. On the other hand, whether statins could reduce cardiovascular events in patients with ESRD is still debatable.…”

“…At least, more careful follow‐up with optimal medical therapy is mandatory in patients with ESRD after FFR‐guided deferral of revascularization. 18 In addition, as FFR is an index specific to epicardial coronary stenosis, assessing various aspects (eg, thrombotic risk, plaque vulnerability, and lesion complexity) might help stratify the risk of future cardiovascular events in patients with deferred lesions, especially those with ESRD. 19 , 20 …”

Circulating trimethylamine N-oxide is correlated with high coronary artery atherosclerotic burden in individuals with newly diagnosed coronary heart disease

“…Once involved in the coronary vessels, partial or total vessel occlusion can lead to gradual reduction or complete block of coronary blood flow [21,22]. Patients suffered from this condition may present as asymptomatic disease, angina pectoris, or myocardial infarction, and finally result in cardiovascular events such as heart failure, arrhythmias, and death [23]. Therefore, there is an urgent need to develop effective risk prediction models to identify individuals with high atherosclerotic burdens and adverse outcomes.…”

Medication Adherence in Cardiovascular Diseases

“…Optimal adherence to guideline-directed medication therapy (i.e. a combination of antiplatelet drugs, ACEIs/ARBs, BBs, and statins) that reduced the risk of MACEs (HR 0.41, 95% CI 0.18-0.92, P = 0.03) was reported [55].…”