Reaching Optimal Medical Tx Prior to Stent Implantation is Key
HealthDay News — In patients with coronary artery disease (CAD), achievement of optimal medical therapy (OMT) before implantation of a drug-eluting stent significantly reduces subsequent cardiac events, according to a study published in the September 15 issue of The American Journal of Cardiology.
Raisuke Iijima, MD, from the Ohashi Medical Center in Tokyo, and colleagues included data from 3,004 patients with CAD treated with drug-eluting stents from 123 participating Japanese centers to examine whether achievement of OMT before implantation of a drug-eluting stent had clinical benefit. OMT achievement was defined as control of blood pressure (<130/80mmHg), hemoglobin A1c (<7.0%), and low-density lipoprotein cholesterol (<100mg/dL).
The researchers found that only 18.2% of patients had achieved all three target criteria (the achieved-OMT group) immediately before the procedure, while the remaining patients failed to achieve one or more criteria (non-OMT group). The incidence of target vessel failure at 24 months was 7.0 versus 10.0% in the achieved-OMT versus non-OMT group (hazard ratio, 0.68; P=0.03). The achieved-OMT group also had lower incidence of non-Q-wave myocardial infarction than the non-OMT group (0.5 versus 1.5%; P=0.08). The only protective predictor of 24-month target vessel failure was hemoglobin A1c <7.0% (odds ratio, 0.56; P<0.01).
"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," the authors write. "Achievement of OMT is still insufficient in modern clinical practice."
One author disclosed financial ties to the pharmaceutical industry.