Coronary Artery Bypass Graft Versus Percutaneous Coronary Intervention: Meds Matter: Impact of Adherence to Medical...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Outcomes Research

Background:

• Coronary revascularization strategies like CABG and PCI are widely compared.
• Medical therapy adherence is known to influence treatment outcomes.
• Long-term effects of medication compliance on CABG vs. PCI outcomes require further definition.

Purpose of the Study:

• To investigate the long-term influence of medical therapy adherence on major adverse cardiac events (MACE) after coronary revascularization.
• To compare the effectiveness of CABG versus PCI in relation to patient compliance with optimal medical therapy.

Main Methods:

• Retrospective analysis of non-ST-segment-elevation myocardial infarction patients undergoing CABG or PCI.
• Follow-up for up to 8 years to assess medication history and MACE (mortality, MI, reintervention).
• Statistical analysis included Kaplan-Meier survival, Cox regression, and propensity score matching.

Main Results:

• Adherence to antiplatelet, lipid-lowering, and beta-blocker therapy significantly improved MACE-free survival in both CABG and PCI groups.
• Optimal medical therapy compliance was a stronger predictor of survival than the revascularization strategy.
• CABG showed superior outcomes to PCI in non-adherent patients, but outcomes were comparable in adherent patients.

Conclusions:

• Medication adherence profoundly impacts long-term outcomes irrespective of the revascularization strategy.
• PCI and CABG may offer similar outcomes in patients adherent to optimal medical therapy.
• CABG provides better MACE-free survival for patients nonadherent to medical therapy, suggesting compliance should guide treatment decisions.