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Prognostic impact of guideline-directed medical therapy after functionally complete revascularisation in patients

Yingyang Geng1, Changdong Guan1, Yao Jiang1

  • 1Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Heart (British Cardiac Society)
|August 8, 2025
PubMed

Insights

Guideline-directed medical therapy (GDMT) significantly reduces adverse cardiac events in patients achieving functional complete revascularisation (FCR) after percutaneous coronary intervention, with benefits emerging by the second year post-procedure.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Functional complete revascularisation (FCR) is linked to better prognosis after percutaneous coronary intervention (PCI).
  • The impact of guideline-directed medical therapy (GDMT) on outcomes in patients with FCR needs further investigation.
  • The FAVOR III China trial provides data on PCI outcomes in a large patient cohort.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of patients who achieved FCR.
  • To determine if adherence to GDMT influences major adverse cardiac and cerebrovascular events (MACCE) in patients with FCR.
  • To assess the timing and significance of GDMT benefits in the context of FCR.

Main Methods:

  • Analysis of patients from the FAVOR III China trial who achieved FCR (defined by QFR ≤0.80).
  • Patients were categorized into GDMT (all 4 recommended agents) and non-GDMT (0-3 agents) groups.
  • The primary endpoint was MACCE (death, MI, stroke, revascularisation) assessed at 3 years.

Main Results:

  • Among 3221 patients with FCR, GDMT adherence decreased over time, with 35.3% adhering at 3 years.
  • Overall MACCE occurred in 10.2% of patients within 3 years.
  • While MACCE rates were similar in the first year, the GDMT group showed significantly lower rates from year 2 (adjusted HR: 0.66) and sustained through year 3 (adjusted HR: 0.65).

Conclusions:

  • Good adherence to GDMT provides significant, sustained benefits in reducing MACCE for patients who have achieved FCR.
  • These benefits become statistically significant starting from the second year post-PCI and continue up to 3 years.
  • GDMT remains crucial for optimizing long-term outcomes even after successful FCR.
Abstract

Keywords:
Coronary Artery DiseasePercutaneous Coronary InterventionPharmacology, ClinicalTreatment Outcome

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