CVIA Journal

Cardiovascular Innovations and Applications


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.

Cardiovascular Innovations and Applications is indexed in the OCLC, Primo Central (Ex Libris), Sherpa Romeo, NISC (National Information Services Corporation), DOAJ and Index Copernicus Databases
EX-Lib-90x50 OCLC-90x50 sherpa NISC logo Directory of Open Access Journals index-copernicus logo
CVIA Journal © 2015