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Updated: Jan 4, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Medical Therapy Utilization and Long-Term Outcomes Following Percutaneous Coronary Intervention: Five-Year Results
Joe X Xie1,2, Elise C Gunzburger3, Lindsay Kaun3
1Emory University School of Medicine, Atlanta, GA (J.X.X., K.M.).
Insights
Long-term use of optimal medical therapy after percutaneous coronary intervention (PCI) declines significantly, impacting patient outcomes. Maintaining adherence to these essential medications is crucial for secondary prevention and reducing major adverse cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Optimal medical therapy is guideline-recommended for ischemic heart disease.
- Long-term utilization and clinical outcome associations post-percutaneous coronary intervention (PCI) are understudied.
- This study assesses longitudinal trends in medical therapy use after PCI.
Purpose of the Study:
- To evaluate long-term trends in the use of four key medical therapies after PCI.
- To determine the association between medical therapy adherence and major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective analysis of 57,900 Veteran Affairs patients undergoing PCI (2005-2014).
- Assessed utilization of statins, beta-blockers, ACE inhibitors/ARBs, and P2Y12 inhibitors at multiple time points post-PCI.
- Used multivariable Cox regression to link therapy use with MACE (all-cause mortality, MI, stroke, repeat revascularization).
Main Results:
- Medical therapy use declined significantly over 5 years post-PCI.
- P2Y12 inhibitor use dropped sharply after 1 year.
- Each therapy class and composite use were associated with reduced MACE; statins (HR 0.77) and P2Y12 inhibitors (HR 0.82) showed the largest effects.
Conclusions:
- Medical therapy use consistently decreases over time following PCI, correlating with poorer outcomes.
- Enhanced strategies are necessary to improve long-term adherence to secondary prevention therapies post-revascularization.
Background:
Optimal medical therapy is endorsed by national guidelines in the management of ischemic heart disease; however, few studies have examined its long-term utilization following percutaneous coronary intervention (PCI) and association with clinical outcomes. We sought to assess longitudinal trends in medical therapy use after PCI and its prognostic significance.
Methods And Results:
From the Veteran Affairs Clinical Assessment, Reporting, and Tracking System Program, we retrospectively identified 57 900 Veteran's Affairs patients undergoing PCI from January 2005 to May 2014. Using prescription fill dates, the utilization of 4 classes of medical therapy including statins, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, P2Y12 inhibitors, and their composites were assessed at discharge, 6 months, 1, 3, and 5 years post-PCI. Multivariable Cox regression models were developed to assess the association between medical therapy status and major adverse cardiovascular events, defined as all-cause mortality, rehospitalization for myocardial infarction, rehospitalization for stroke, or repeat revascularization. At discharge following PCI, 58.3% of patients received all 4 classes of medical therapy. Utilization of statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased from 89%, 84.9%, and 72.2% on discharge, respectively, to 72.7%, 67.9%, and 57.9% at 5 years. Prescription refills of P2Y12 inhibitors declined from 96.5% on discharge to 28.3% at 5 years, driven by a large decline in P2Y12 inhibitor use after 1 year. Use of each class of medical therapy, and its composite use, was associated with a significant reduction in major adverse cardiovascular events at 5 years, with the largest effect size seen by the use of statins (HR, 0.77; 95% CI, 0.75-0.79; P<0.0001) and P2Y12 inhibitors (HR, 0.82; 95% CI, 0.79-0.85; P<0.0001).
Conclusions:
Consistent declines in medical therapy use following PCI were observed over time, which is associated with worse outcomes. Further efforts are needed to promote long-term adherence to secondary prevention therapies after revascularization.
