title: Effect of Optimal Medical Therapy Before Procedures on Outcomes in Coronary Patients Treated With Drug-Eluting Stents.
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.
authors.affiliation: Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan. Electronic address: raisuke@live.jp.
authors.forename: Raisuke
authors.initials: R
authors.lastname: Iijima
authors.affiliation: Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.affiliation: Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.affiliation: Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Hara
authors.affiliation: Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Okada
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
authors.affiliation: Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.affiliation: Division of Cardiology, Ayase Heart Hospital, Tokyo, Japan.
authors.forename: Hidenari
authors.initials: H
authors.lastname: Hozawa
authors.affiliation: Division of Cardiology, Chikamori Hospital, Kochi, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Awata
authors.affiliation: Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mukawa
authors.affiliation: Division of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Superintendent, Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D054855:Drug-Eluting Stents; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D020123:Sirolimus / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D017239:Paclitaxel; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus; C517652:hemoglobin A1c protein, human