Nakamura Y, et al. - Researchers determined the influence of optimal medical therapy (OMT) in post-coronary artery bypass grafting (CABG) patients undergoing percutaneous coronary intervention (PCI) as secondary revascularization. They observed a protective role of OMT in these patients. OMT resulted in a decrease of all-cause death in post-CABG patients requiring subsequent PCI. In this patient population, OMT could be considered essential treatment outside of the area of coronary revascularization.

Methods

• This study included a total of 632 consecutive post-CABG patients undergoing PCI between 2001 and 2013 at the researchers' hospital (84% males, median age 71 years).
• Patients were classified as those who were discharged with and 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.

Results

• A higher prevalence of clinical comorbidities was reported in patients with OMT (n = 163).
• These patients had a lower prevalence of all-cause death, relative to 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).
• Procedural success rates were similar for both groups.
• In a propensity-matched cohort (n = 146 each), OMT vs non-OMT was found to be related to lower rates of all-cause death and cardiac death at 8 years after PCI.
• OMT was identified as an independent predictor of all-cause death in multivariable analysis (hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.34–0.72; p < 0.001).