Post-CABG, PCI Medical Therapy Adherence

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There was a correlation between lower use of medical therapy and adverse clinical outcomes in PCI vs CABG at 5 years.
There was a correlation between lower use of medical therapy and adverse clinical outcomes in PCI vs CABG at 5 years.

HealthDay News — Compliance with guideline-directed medical therapy (GDMT) is low, and remains higher in percutaneous coronary intervention (PCI) than in coronary artery bypass grafting (CABG), according to a review published in the Journal of the American College of Cardiology.

Ana-Catarina Pinho-Gomes, from the Oxford University Hospitals NHS Trust in the United Kingdom, and colleagues reviewed data from randomized controlled trials comparing PCI with drug-eluting stents vs CABG that reported medical therapy after revascularization. The review outcome was compliance with GDMT. Data were included from 5 trials that met the inclusion and exclusion criteria.

The researchers found that compliance with any antiplatelet agent plus beta-blocker plus statin (GDMT1) was low, and decreased from 67% at 1 year to 53% at 5 years. Even lower compliance was seen with any antiplatelet agent plus beta-blocker plus statin plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (GDMT2), which decreased from 40% at 1 year to 38% at 5 years. At all time points, compliance with GDMT1 and GDMT2 was higher in PCI than CABG. There was a correlation between lower GDMT1 use and adverse clinical outcomes in PCI vs CABG at 5 years.

"Compliance with GDMT in contemporary clinical trials remains suboptimal and is significantly lower after CABG than after PCI, which may influence the comparison of clinical trial end points between those study groups," the authors wrote.

Disclosures: One author disclosed financial ties to Amgen.

Reference

Pinho-Gomes AC, Azevedo L, Ahn JM, et al. Compliance with guideline-directed medical therapy in contemporary coronary revascularization trials [published online February 6, 2018]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.11.068

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