Current trends in optimal medical therapy after PCI and its influence on clinical outcomes in China

Abstract

Background Limited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. We aimed to evaluate the utilization and impact of OMT on the main adverse cardiovascular and cerebrovascular events (MACCEs) in post-PCI patients and analyzed the factors predictive of OMT after discharge. Methods We collected data from 3812 individuals from 2016.10 to 2017.09 at TEDA International Cardiovascular Hospital. They were classified into an OMT group and a non-OMT group according to their OMT status, which was defined as the combination of dual antiplatelet therapy, statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after PCI. Multivariable Cox regression models were developed to assess the association between OMT and MACCEs, defined as all-cause mortality, nonfatal myocardial infarction, stroke, and target vessel revascularization. A logistic regression model was established to analyze the factors predictive of OMT. Results Our results revealed that the proportion of patients receiving OMT and its component drugs decreased over time. A total of 36.0% of patients were still adherent to OMT at the end of follow-up. Binary logistic regression analysis revealed that baseline OMT (P < 0.001, OR = 52.868) was the strongest predictor of OMT after PCI. The Cox hazard model suggested that smoking after PCI was associated with the 1-year risk of MACCE (P = 0.001, HR = 2.060, 95% CI 1.346–3.151), while OMT (P = 0.001, HR = 0.486, 95% CI 0.312–0.756) was an independent protective factor against postoperative MACCEs. Conclusions There was still a gap between OMT utilization after PCI and the recommendations in the evidence-based guidelines. Sociodemographic and clinical factors influence the application of OMT. The management of OMT and smoking cessation after PCI should be emphasized.

Smoking and outcomes following personalized antiplatelet therapy in chronic coronary syndrome patients: A substudy from the randomized PATH‐PCI trial

“…22 Based on the evidence of an observation study, the incidence of MACCE in patients after PCI was increased 1.060 times by smoking. 23 Smoking increased the production of clopidogrel active metabolites by inducing CYP1A2 activity. 24 This effect was more notable in high-risk patients, especially those with ACS, a circumstance defined as the "smoking paradox."…”

“…Compared with nonsmokers, smokers seemed to have a higher short‐term mortality rate after PCI 22 . Based on the evidence of an observation study, the incidence of MACCE in patients after PCI was increased 1.060 times by smoking 23 . Smoking increased the production of clopidogrel active metabolites by inducing CYP1A2 activity 24 .…”

“… 22 Based on the evidence of an observation study, the incidence of MACCE in patients after PCI was increased 1.060 times by smoking. 23 Smoking increased the production of clopidogrel active metabolites by inducing CYP1A2 activity. 24 This effect was more notable in high‐risk patients, especially those with ACS, a circumstance defined as the “smoking paradox.” 25 The PARADOX study suggested that nonsmokers who received clopidogrel had a weaker antiplatelet effect than smokers, nonsmokers saw little or no benefit from clopidogrel treatment, especially in ACS patients.…”

Temporal characteristics and associated factors of discontinuation and outcomes after percutaneous coronary intervention

“…We identified the final participants for the following reasons. (1) Most existing post-PCI surveys focus on the first 3 years after PCI, and there are fewer data on the follow-up of patients beyond 3 years after PCI ( Zhang et al, 2021 ; Zhang et al, 2023 ). (2) Our pre-survey showed that the success rate of surveying patients more than 10 years after PCI was very low (<20%) due to patient death, change of contact phone number, and unwillingness to cooperate.…”