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[The application status of optimal medical therapy after percutaneous coronary intervention and its influence on

J Zhang¹, R Jing¹, J J Liu¹

¹Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin 300457, China.

Zhonghua Yi Xue Za Zhi

|April 20, 2021

Insights

Optimal medical therapy (OMT) use after percutaneous coronary intervention (PCI) is suboptimal and declines over time. Adherence to OMT significantly reduces major adverse cardiovascular events and improves patient prognosis.

Area of Science:

Cardiology
Interventional Cardiology
Clinical Outcomes

Background:

Percutaneous coronary intervention (PCI) is a common treatment for coronary heart disease (CHD).
Optimal medical therapy (OMT) is crucial for managing CHD post-PCI.
The application status and prognostic impact of OMT after PCI require investigation.

Purpose of the Study:

To assess the utilization of OMT in CHD patients post-PCI.
To evaluate the influence of OMT adherence on 1-year prognosis after PCI.
To identify factors associated with major adverse cardiovascular and cerebrovascular events (MACCE) post-PCI.

Main Methods:

Prospective data collection from 3,812 CHD patients undergoing PCI.
Categorization into OMT and non-OMT groups based on adherence.
Statistical analysis including Chi-square tests and Cox regression models.
Recording of MACCE during hospitalization and at 1, 6, and 12 months post-discharge.

Main Results:

OMT utilization decreased from 58.8% during hospitalization to 36.0% at 12 months post-discharge.
Significant decline observed in the use of beta-blockers and ACEI/ARB over time.
OMT adherence was identified as an independent protective factor against postoperative MACCE (HR=0.471, P=0.001).
Elderly patients, comorbidities, and lesion characteristics were associated with MACCE.

Conclusions:

OMT application post-PCI is suboptimal and diminishes over time, particularly for beta-blockers and ACEI/ARB.
Adherence to OMT significantly reduces MACCE incidence and improves long-term prognosis in post-PCI patients.
Targeted interventions are needed to improve OMT adherence and patient outcomes.

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Abstract:

Objective: To investigate the application status of optimal medical therapy (OMT) in patients with coronary heart disease after percutaneous coronary intervention (PCI) and its influence on the 1-year prognosis of patients after surgery. Methods: Data of 3 812 patients diagnosed with coronary heart disease by coronary angiography and successfully completed PCI in the Department of Cardiology, TEDA International Cardiovascular Hospital from October 2016 to September 2017 were prospectively collected. The OMT status and the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospitalization and 1, 6, and 12 months after discharge were recorded. Patients were divided into OMT group (n=1 299) and non-OMT group (n=2 289) according to their adherence to OMT after PCI. Chi-square test was used to compare the differences of MACCE between groups, and to screen for significant differences and clinically significant variables between groups. Cox regression model was used to analyze the influencing factors of MACCE after PCI. Results: Among 3 588 patients (224 cases lost to follow-up), 58.8% (2 110/3 588) used OMT during hospitalization after PCI, and 36.0% (1 293/3 588) still adhered to OMT after 12 months of follow-up. The utilization rates of OMT showed a decreasing trend, among which till the 12^th month, β-blockers and ACEI/ARB showed the greatest decreasing degree, from 75.3%(2 701/3 588) and 75.1%(2 692/3 588) to 59.1%(2 122/3 588) and 53.0%(1 903/3 588). Pearson χ² analysis showed that elderly patients, the number of amalgamative diseases, history of PCI, history of chronic myocardial infarction, history of chronic renal insufficiency, the lesion counts, lesion type, the Gensini score, adhere to the OMT and smoking during the follow-up were related to postoperative MACCE, the difference was statistically significant (P<0.05). Cox regression model showed that OMT adherence after PCI was an independent protective factor for postoperative MACCE events (HR=0.471,95%CI: 0.300-0.734, P=0.001). Conclusion: The application of OMT after PCI was suboptimal, and the application rate decreased with the lengthening of the discharge time, among which the use of ACEI/ARB and β-blockers deserved more attention. Adherence to OMT after PCI was an independent protective factor, which could reduce the incidence of postoperative MACCE and improve the prognosis of patients.

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