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Impact of Optimal Medical Therapy on Long-Term Outcomes After Myocardial Revascularization for Multivessel Coronary Disease

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Abstract
Although optimal medical therapy (OMT) after coronary revascularization is advocated for intensive secondary prevention, its criteria and effect on long-term outcomes are uncertain. Using data from the ASAN-Multivessel (Asan Medical Center-Multivessel Revascularization) registry, we identified 8,311 patients who underwent coronary artery bypass grafting (CABG) (n = 3,115) or percutaneous coronary intervention (PCI) (n = 5,196). OMT was defined as the combination of minimum of 3 medications in 4 drug classes (antiplatelet drugs, statins, β blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Two primary outcomes were all-cause mortality and serious composite outcome of death, spontaneous myocardial infarction, or stroke at 10 years. Of 8,311 patients, 4,321 (52.0%) followed OMT. In the 3,397 propensity-score-matched cohort, OMT status compared with non-OMT status was significantly associated with a lower risk of all-cause mortality (10.7% vs 18.7%; hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.47 to 0.65) and serious composite outcome (14.5% vs 22.5%, HR 0.635, 95% CI 0.55 to 0.73) at 10 years. The association on 10-year mortality was more prominent in the PCI group (HR 0.45, 95% CI 0.36 to 0.56) than in the CABG group (HR 0.72, 95% CI 0.58 to 0.90) with a significant interaction (p = 0.001). Overall findings were consistent using different OMT criteria (all 4 types of medications). In conclusion, OMT significantly lowered the risks of mortality and major cardiovascular events at 10 years in patients with multivessel revascularization. The OMT impact on mortality was more remarkable in the PCI group than in the CABG group. This work was registered at http://ClinicalTrials.gov (Identifier: NCT02039752).
Author(s)
Jinsun ParkSe Hee KimMijin KimJinho LeeYeonwoo ChoiHoyun KimTae Oh KimDo-Yoon KangJung-Min AhnJae-Suk YooHo Jin KimJoon Bum KimSuk Jung ChooCheol-Hyun ChungSeung-Jung ParkDuk-Woo Park
Issued Date
2023
Type
Article
Keyword
AngiotensinsCerebral infarctionEndocrine SystemEnzyme inhibitorsEnzymesHealth facilitiesMortalityMyocardial infarctionStroke
DOI
10.1016/j.amjcard.2023.06.083
URI
https://oak.ulsan.ac.kr/handle/2021.oak/16843
Publisher
AMERICAN JOURNAL OF CARDIOLOGY
Language
영어
ISSN
0002-9149
Citation Volume
203
Citation Number
1
Citation Start Page
81
Citation End Page
91
Appears in Collections:
Medicine > Nursing
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