Optimal medical therapy in patients with chronic coronary syndrome undergoing PCI: Temporal trends and outcomes

Contemporary real-world data describing temporal trends in optimal medical therapy (OMT) in patients with chronic coronary syndrome undergoing percutaneous coronary intervention, particularly in the context of residual risk factors, are limited. We sought to evaluate temporal trends in pre-procedural OMT, and their impact on outcomes in this patient population.

We included consecutive patients with stable angina and objective evidence of myocardial ischemia who underwent percutaneous coronary intervention at a single quaternary referral center between January 2012 and December 2023. Patients were stratified according to pre-procedural medical therapy intensity and uncontrolled cardiometabolic risk factors. The primary outcome was major adverse cardiovascular events (MACE) defined as composite of all-cause death, myocardial infarction, stroke, or target vessel revascularization assessed at 1-year follow-up.

Among 9766 patients with chronic coronary syndrome (mean [SD] age was 67.0 [10.5] years; 27.1% female), significant trends were observed toward an increased proportion of patients presenting with more intensive medical therapy and with improved risk factor control. At 1-year, patients receiving high intensity therapy had higher rates of MACE compared with those receiving low intensity therapy (9.5% versus 6.8%; HR, 1.40; P < 0.01), but lower all-cause death (1.1% versus 1.8%; HR, 0.59; P = 0.04). Similarly, the high risk patients experienced higher MACE compared with the low risk patients (10.8% versus 7.9%; HR, 1.39; P < 0.01). No significant differences were observed in moderate intensity treatment and intermediate risk groups.

Despite improvements in medical therapy optimization and risk factors, residual risk remained and was associated with adverse outcomes.