The impact of optimal medical therapy on prognosis of patients with coronary atherosclerosis
Jingwen Yong Yujie Zhou Zhijian Wang
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
Objectives: To investigate the prevalence of OMT in patients with various coronary stenosis severities and its impact on clinical prognosis.
Methods: A total of 11490 patients undergoing invasive coronary angiography for suspected coronary artery disease (CAD) were grouped according to coronary stenosis severity: patients with obstructive CAD (luminal stensosis ≥50%, n=6416), non-obstructive CAD (stenosis <50%, n=3748) and angiographic normal patients (n=1326). The prevalence of OMT and its impact on prognosis were compared across three groups. OMT was defined as a combination of statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in patients with an American College of Cardiology/American Heart Association class I indication for each medication. The primary endpoint was the major adverse cardiovascular events, which was the composite of death, myocardial infarction, or repeat revascularization.
Results: With increasing coronary severity, we observed a progressively increased prevalence of risk factors, higher risk of MACE (MACE was 0.9% vs. 5.4% vs. 11.0% in patients with normal, non-obstructive and obstructive CAD, P < 0.001), and higher prevalence of OMT (95.1% vs. 98.2% vs. 99.4%, P < 0.001). Although there was an interaction between the impact of OMT on MACE and coronary severity (interaction p = 0.038), OMT was an independent predictor of improved MACE in patients with either obstructive CAD (HR: 0.72, 95% CI:0.62-0.84, p = 0.002) or non-obstructive CAD (HR: 0.87, 95% CI: 0.76-0.99, p = 0.046).
Conclusions: The prevalence of OMT is lower in patients with non-obstructive CAD compared with patients with obstructive CAD. Although the impact is weaker in non-obstructive CAD patients, OMT is an independent predictor of improved prognosis in patients with either non-obstructive or obstructive CAD.