Medical Therapy Compliance After Coronary Revascularization

Study Questions:

What are rates of medical compliance with guideline-directed medical therapy (GDMT) in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) trials?

Methods:

This was a meta-analysis/systematic review of six trials that compared drug-eluting stent PCI to CABG and had data available on medical therapy post-revascularization. The primary outcome was: GDMT1: use of any antiplatelet agent, beta-blocker, and statin; GDMT2: any antiplatelet agent, beta-blocker, statin, and angiotensin-converting enzyme inhibitor (ACEI), and/or angiotensin-receptor blocker. Differences between CABG and PCI were assessed out to 5 years post-revascularization.

Results:

All six studies were large, multicenter, randomized, controlled trials comparing drug-eluting stent PCI to CABG. A total of over 7,000 patients were analyzed. Compliance with GDMT1 was low and decreased over time from 67% at 1 year to 53% at 5 years. Compliance with GDMT2 was even lower and decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1 and GDMT2 was higher in PCI than in CABG at all time points. There was a significant association between lower use of GDMT1 and adverse clinical outcomes in PCI versus CABG at 5 years.

Conclusions:

The authors concluded that compliance with GDMT after revascularization is low. Patients undergoing CABG are less likely to be on GDMT compared to PCI, and this may influence long-term outcomes.

Perspective:

This analysis highlights significant room for improvement in ensuring compliance with GDMT post-revascularization and that patients undergoing CABG have lower rates of compliance compared to patients undergoing PCI. The latter finding is somewhat driven by less use of an additional antiplatelet agent among patients post-CABG. Regardless, defining potential ways to mitigate noncompliance with life-saving therapies after revascularization should be a priority.

Clinical Topics: Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Nonstatins, Novel Agents, Statins

Keywords: Adrenergic beta-Antagonists, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cardiac Surgical Procedures, Coronary Artery Bypass, Drug-Eluting Stents, Guideline Adherence, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Myocardial Revascularization, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Secondary Prevention


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