Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization
Hideyuki Kawashima1, Patrick W Serruys2, Masafumi Ono3
1Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: https://twitter.com/HideyukiKawash2.
Insights
Optimal medical therapy (OMT) significantly improves 10-year survival in patients with complex coronary artery disease after PCI or CABG. Maintaining OMT at 5 years is crucial for long-term benefits.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- The SYNTAX trial demonstrated the 5-year benefits of optimal medical therapy (OMT) in patients with 3-vessel and/or left main coronary artery disease treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- This study investigates the long-term impact of OMT on mortality up to 10 years post-intervention.
Purpose of the Study:
- To assess the impact of optimal medical therapy (OMT) status at 5 years on 10-year mortality in patients who underwent PCI or CABG.
- To evaluate the association between adherence to guideline-recommended pharmacologic therapy and long-term survival outcomes.
Main Methods:
- A subanalysis of the SYNTAXES study, evaluating 10-year vital status of SYNTAX trial participants.
- Optimal medical therapy (OMT) defined as a combination of antiplatelet, statin, ACE inhibitor/ARB, and beta-blocker.
- Landmark analysis conducted at 5 years, stratifying patients by OMT adherence and treatment received (PCI vs. CABG).
Main Results:
- Patients on OMT at 5 years showed significantly lower 10-year mortality (13.1%) compared to those on ≤2 medications (19.9%; aHR: 0.470).
- Mortality was similar between patients on OMT and those on 3 OMT agents at 5 years.
- For patients undergoing CABG, use of antiplatelet and statin at 5 years was associated with lower 10-year mortality.
Conclusions:
- Medication status at 5 years significantly impacts 10-year mortality in patients with 3-vessel and/or left main disease after PCI or CABG.
- Adherence to optimal medical therapy (OMT) at 5 years confers a survival benefit, underscoring the importance of guideline-recommended pharmacologic therapy.
Background:
The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.
Objectives:
The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG.
Methods:
This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial. OMT was defined as the combination of 4 types of medications: at least 1 antiplatelet drug, statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. After stratifying participants by the number of individual OMT agents at 5 years and randomized treatment, a landmark analysis was conducted to assess the association between treatment response and 10-year mortality.
Results:
In 1,472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on ≤2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; 95% CI: 0.292-0.757; P = 0.002) but had a mortality similar to those on 3 types of medications. Furthermore, patients undergoing CABG with the individual OMT agents, antiplatelet drug and statin, at 5 years had lower 10-year mortality than those without.
Conclusions:
In patients with 3-vessel and/or left main disease undergoing percutaneous coronary intervention or CABG, medication status at 5 years had a significant impact on 10-year mortality. Patients on OMT with guideline-recommended pharmacologic therapy at 5 years had a survival benefit. (Synergy Between PCI With Taxus and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
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