Current trends in optimal medical therapy after PCI and its influence on clinical outcomes in China

Jian Zhang,Wen-Hua Lin,Rui-Fei Yang,Jing-Jing Liu,Jing-Yan Hao,Cheng-Ye Di,Yu-Jie Lu,Rui Jing,Ya-Jie Wang,Peng Gao

doi:10.1186/s12872-021-02052-z

Abstract

BackgroundLimited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. We aimed to evaluate the utilization and impact of OMT on the main adverse cardiovascular and cerebrovascular events (MACCEs) in post-PCI patients and analyzed the factors predictive of OMT after discharge.MethodsWe collected data from 3812 individuals from 2016.10 to 2017.09 at TEDA International Cardiovascular Hospital. They were classified into an OMT group and a non-OMT group according to their OMT status, which was defined as the combination of dual antiplatelet therapy, statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after PCI. Multivariable Cox regression models were developed to assess the association between OMT and MACCEs, defined as all-cause mortality, nonfatal myocardial infarction, stroke, and target vessel revascularization. A logistic regression model was established to analyze the factors predictive of OMT.ResultsOur results revealed that the proportion of patients receiving OMT and its component drugs decreased over time. A total of 36.0% of patients were still adherent to OMT at the end of follow-up. Binary logistic regression analysis revealed that baseline OMT (P < 0.001, OR = 52.868) was the strongest predictor of OMT after PCI. The Cox hazard model suggested that smoking after PCI was associated with the 1-year risk of MACCE (P = 0.001, HR = 2.060, 95% CI 1.346–3.151), while OMT (P = 0.001, HR = 0.486, 95% CI 0.312–0.756) was an independent protective factor against postoperative MACCEs.ConclusionsThere was still a gap between OMT utilization after PCI and the recommendations in the evidence-based guidelines. Sociodemographic and clinical factors influence the application of OMT. The management of OMT and smoking cessation after PCI should be emphasized.

Highlights

Limited data were available on the current trends in optimal medical therapy (OMT) after percutaneous coronary intervention (PCI) and its influence on clinical outcomes in China
The following were exclusion criterion: (1) a definite history of allergy and allergies to or intolerance of the drugs recommended by the guidelines; (2) a diagnosis of malignant tumors or a life expectancy < 1 year; (3) a diagnosis of an immune system disease and/or taking hormones therapy; (4) a serum creatinine level ≥ 265 mol/L or renal failure detected in the past or during hospitalization; (5) lack of autonomy or a diagnosis of a mental illness; (6) incomplete clinical data or coronary angiography data; and (7) in-hospital death after PCI
The median follow-up was 13.0 months; 224 patients were lost to follow-up, and 3588 patients were included in the statistical analysis (Fig. 1)

Summary

Introduction

Limited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. Zhang et al BMC Cardiovasc Disord (2021) 21:258 non-cardiovascular death and other ischemic events driven by atherosclerosis after percutaneous coronary intervention (PCI) remain concerning [5]. The progression of atherosclerosis does not stop, even in patients who have undergone coronary revascularization with PCI or coronary artery bypass grafting (CABG) [7]. Revascularization with PCI or CABG has repeatedly demonstrated to be the best treatment for patients with severe coronary stenosis or occlusion, intraoperative or perioperative medical therapy is generally emphasized. Concomitant optimal medical therapy (OMT) is often ignored after patients have undergone PCI

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