Comparison of Long-Term Mortality in Patients With Previous Coronary Artery Bypass Grafting Who Underwent Percutaneous Coronary Intervention With Versus Without Optimal Medical Therapy

• Published in: The American journal of cardiology Vol. 122; no. 2; pp. 206 - 212
• Main Authors: Nakamura, Yuichi, Asaumi, Yasuhide, Miyagi, Tadayoshi, Nakai, Michikazu, Nishimura, Kunihiro, Sugane, Hiroki, Matama, Hideo, Kataoka, Yu, Miyamoto, Yoshihiro, Takeishi, Yasuchika, Noguchi, Teruo, Yasuda, Satoshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2018; Elsevier Limited
• Subjects: Acute coronary syndromes; Age; Aged; Angioplasty; Angiotensin-converting enzyme inhibitors; Atherosclerosis; Cardiac arrhythmia; Cardiovascular disease; Cause of Death - trends; Clinical outcomes; Confidence intervals; Coronary artery; Coronary Artery Bypass - methods; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary vessels; Death; Diabetes; Enzyme inhibitors; Enzymes; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Gender; Grafting; Heart attacks; Heart failure; Heart surgery; Hospitals; Humans; Hypertension; Intervention; Kidney diseases; Male; Medical imaging; Mortality; Patients; Peptidyl-dipeptidase A; Percutaneous Coronary Intervention - methods; Prognosis; Reoperation; Retrospective Studies; Risk Factors; Statins; Stents; Survival Rate - trends; Therapy; Thrombolytic Therapy - methods; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.04.009

Although current guidelines have highlighted the importance of evidence-based optimal medical therapy (OMT) in patients with previous coronary artery bypass grafting (CABG), the effect of OMT on post-CABG patients requiring secondary coronary revascularization on prognosis remains unknown. We sought to examine the impact of OMT on post-CABG patients who underwent percutaneous coronary intervention (PCI) as secondary revascularization. A total of 632 consecutive post-CABG patients who underwent PCI between 2001 and 2013 at our hospital (84% men, median age 71 years) were divided into 2 groups: patients who were discharged with OMT and patients who were discharged without OMT (non-OMT). OMT was defined as the combination of an antiplatelet agent, statin, β blocker, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Despite having a higher prevalence of clinical comorbidities, patients with OMT (n = 163) had a lower prevalence of all-cause death than those without OMT (n = 469) during a median follow-up of 95 months (OMT group 21.5%, non-OMT group 34.1%, p = 0.002). Both groups had similar procedural success rates. In a propensity-matched cohort (n = 146 each), OMT was associated with lower rates of all-cause death and cardiac death than non-OMT 8 years after PCI. In multivariable analysis, OMT was an independent predictor of all-cause death (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.34 to 0.72, p <0.001). In conclusion, OMT plays a protective role and reduces all-cause death in post-CABG patients requiring subsequent PCI. Outside of the domain of coronary revascularization, OMT could be considered an essential treatment in this patient population.