TCT-116 Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization

Kawashima, Hideyuki; Serruys, Patrick W.; Ono, Masafumi; McEvoy, John W.; Onuma, Yoshinobu

doi:10.1016/j.jacc.2021.09.966

Cited by 4 publications

(4 citation statements)

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“…Considering that the baseline characteristics of patients in the OMT group included a higher risk pro le, this implies that OMT could be advantageous in reducing the occurrence of adverse clinical outcomes. Therefore, these ndings are consistent with those of previous studies showing the bene ts of OMT in reducing the risk of major cardiovascular events in patients with stable CAD (11)(12)(13)(14).…”

Section: Discussionsupporting

confidence: 92%

“…Observational studies and sub-analyses of randomized controlled trials have demonstrated that OMT in patients with CAD is associated with favorable clinical outcomes after PCI (11)(12)(13)(14). However, the patient populations and OMT de nitions vary among these studies, and it remains unclear whether OMT bene ts high-risk patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial

Kwun,

Choi,

Kim

et al. 2023

Preprint

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Coronary artery disease (CAD) is a major global health concern, and percutaneous coronary intervention (PCI) is commonly used for revascularization. Optimal medical therapy (OMT) is recommended to complement PCI. However, whether OMT significantly benefits high-risk CAD patients remains unclear. This study aimed to investigate potential benefits of OMT in high-risk CAD patients who underwent PCI, through a post-hoc subgroup analysis of the POST-PCI trial comparing patients who did and did not receive OMT. The primary endpoint was major cardiovascular events (death from any cause, myocardial infarction, or hospitalization for unstable angina) at 2 years; secondary endpoints included individual components of the primary outcome. The OMT group comprised patients with a higher prevalence of cardiovascular risk factors. However, clinical outcomes did not differ significantly between OMT and non-OMT groups. Additionally, the OMT group had a significantly reduced invasive coronary angiography rate than the non-OMT group (74.0% vs. 89.1%, odds ratio: 0.35, 95% confidence interval: 0.15–0.81, p = 0.014). The non-OMT group tended to have a higher proportion of symptomatic patients undergoing repeat revascularization than the OMT group (81.7% vs. 65.5%, p = 0.070). In conclusion, OMT did not result in significantly different clinical outcomes in high-risk CAD patients post-PCI compared with non-administration of OMT. However, OMT has potential benefits in reducing unnecessary procedures and optimizing patient care. Further studies are needed to better understand OMT benefits in this patient population.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial

Kwun,

Choi,

Kim

et al. 2023

Preprint

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“…In 2021, a sub-analysis of the SYNTAX-trial demonstrated that patients receiving optimal medical therapy at 5 years illustrated a better survival at 10 years than those who did not receive optimal medical therapy. 12 This effect could mainly be attributed to the use of statins and the inhibition of platelet aggregation, which are both associated with infarct-preventing mechanisms. Similar results came from a Swedish registry analysis on patients having survived bypass surgery.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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“…[1][2][3] Graft patency, myocardial infarction (MI), and repeated revascularization are of major concern after CABG. 4 Medical therapy after CABG impacts long-term survival, 5 and antiplatelet therapy plays a crucial role in preventing CABG complications, maintaining graft patency, and preventing ischemic events; however, they could increase the risk of bleeding. 2,6 Several guidelines recommend dual antiplatelet therapy (DAPT) after CABG, with variable duration.…”

Section: Introductionmentioning

confidence: 99%

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

Daoulah,

Qenawi,

Alshehri

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients. Results: This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age (P = 0.451), gender (P = 0.063), smoking (P = 0.941), diabetes mellitus (P = 0.773), history of myocardial infarction (P = 0.709), chronic kidney disease (P = 0.615), atrial fibrillation (P = 0.306), or cerebrovascular accident (P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, −2.08 (95% confidence interval (CI), −20.8–16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, −11.1–19.32); P = 0.595]. There was no difference in bleeding between groups (P = 0.666). Conclusions: DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.

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TCT-116 Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization

Cited by 4 publications

References 0 publications

Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial

Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial

Cardiac Surgery 2021 Reviewed

Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease

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