1. Effect of Optimal Medical Therapy Before Procedures on Outcomes in Coronary Patients Treated With Drug-Eluting Stents.
- Author
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Iijima R, Nakamura M, Matsuyama Y, Muramatsu T, Yokoi H, Hara H, Okada H, Ochiai M, Suwa S, Hozawa H, Kawai K, Awata M, Mukawa H, Fujita H, and Nanto S
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Aged, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antibiotics, Antineoplastic therapeutic use, Antineoplastic Agents, Phytogenic therapeutic use, Blood Pressure, Cholesterol, LDL blood, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Diabetes Mellitus drug therapy, Diabetes Mellitus epidemiology, Diabetes Mellitus metabolism, Dyslipidemias blood, Dyslipidemias drug therapy, Dyslipidemias epidemiology, Female, Glycated Hemoglobin metabolism, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypertension drug therapy, Hypertension epidemiology, Hypoglycemic Agents therapeutic use, Japan, Male, Middle Aged, Paclitaxel therapeutic use, Proportional Hazards Models, Prospective Studies, Randomized Controlled Trials as Topic, Risk Reduction Behavior, Sirolimus therapeutic use, Coronary Artery Disease therapy, Drug-Eluting Stents, Percutaneous Coronary Intervention methods, Platelet Aggregation Inhibitors therapeutic use
- Abstract
It has not been established whether the achievement of optimal medical therapy (OMT) before implantation of a drug-eluting stent has a clinical benefit for patients with stable coronary artery disease (CAD). This study included 3,004 patients with CAD treated with drug-eluting stent from 123 Japanese participating centers. The achievement of OMT was defined as control of blood pressure <130/80 mm Hg, hemoglobin A1c <7.0%, and low-density lipoprotein cholesterol <100 mg/dl. The primary end point was target vessel failure, a composite of death related to the target vessel, myocardial infarction, or clinically driven revascularization at 24 months after stent implantation. Immediately before the procedure, only 548 patients (18.2%) had achieved all 3 target criteria (the achieved OMT group), whereas the remaining 2,456 patients failed to achieve one or more criteria (the non-OMT group). At 24 months, the incidence of target vessel failure was 7.0% in the achieved OMT group versus 10.0% in the non-OMT group (hazard ratio 0.68, 95% CI 0.48 to 0.96, p = 0.03). The incidence of non-Q-wave myocardial infarction was also lower in the achieved OMT group than in the non-OMT group (0.5% vs 1.5%, p = 0.08). Multivariate logistic regression analysis identified that hemoglobin A1c <7.0% was the only protective predictor of 24-month target vessel failure (odds ratio 0.56, 95% CI 0.43 to 0.73, p <0.01). In conclusion, this study demonstrated that in patients with stable CAD scheduled for stent implantation, achievement of OMT before percutaneous coronary intervention significantly reduced subsequent cardiac events. Achievement of OMT is still insufficient in modern clinical practice., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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