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Optimal medical therapy and percutaneous coronary intervention for stable angina: why patients should 'be taking' and

K Mohee1, S B Wheatcroft

  • 1Division of Cardiovascular & Diabetes Research, Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.

Journal of Clinical Pharmacy and Therapeutics
|April 24, 2014
PubMed

Insights

Optimal medical therapy (OMT) is underused in patients undergoing percutaneous coronary intervention (PCI), despite similar outcomes to PCI. Medication adherence is higher with PCI, highlighting the need to ensure patients take OMT.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Optimal medical therapy (OMT) improves outcomes in stable coronary artery disease.
  • Revascularization (PCI) is recommended for persistent symptoms or prognostic benefit despite OMT.
  • International guidelines recommend OMT, yet its utilization is suboptimal in patients referred for PCI.

Purpose of the Study:

  • To comment on recent evidence regarding OMT initiation in percutaneous coronary intervention (PCI) patients.
  • To discuss the potentially higher medication adherence in patients treated with PCI.
  • To explore factors contributing to OMT underprescription and predict adherence in PCI patients.

Main Methods:

  • Review of recent evidence and clinical practice guidelines.
  • Analysis of studies comparing OMT alone versus PCI with OMT.
  • Discussion of factors influencing OMT prescription and patient adherence.

Main Results:

  • Large trials show similar risks of death or myocardial infarction between OMT alone and PCI with OMT.
  • OMT remains underutilized in patients referred for PCI, despite guideline recommendations.
  • Medication adherence is significantly higher in patients treated with PCI compared to OMT alone.

Conclusions:

  • Contemporary studies confirm OMT underutilization in PCI patients but increased adherence with PCI.
  • Increased recognition of OMT as the definitive treatment for stable angina is advocated.
  • Ensuring patients "are taking" and "keep taking" OMT is crucial, especially for those undergoing PCI.
Abstract

Keywords:
CABGPCIcardiovascular diseaseoptimal medical therapystable angina

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