Clinical prognosis of optimal medical therapy after percutaneous coronary intervention in patients with coronary heart disease

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Clinical prognosis of optimal medical therapy after percutaneous coronary intervention in patients with coronary heart disease

Coronary heart disease (CHD) is a leading cause of death worldwide, and percutaneous coronary intervention (PCI)—a procedure to open blocked heart arteries—is a common treatment for severe cases. But even after PCI, the risk of future heart problems remains: atherosclerosis (the buildup of plaque in arteries) continues to progress, and medication adherence plays a critical role in slowing this process. Optimal medical therapy (OMT)—a combination of four key drugs—has been shown to reduce complications, but how well patients in China stick to these drugs long-term, and how that affects outcomes, hasn’t been well-studied. A 2021 study from Chinese researchers aimed to change that.

Led by Jing-Yan Hao from Tianjin Medical University and Wen-Hua Lin from TEDA International Cardiovascular Hospital, the study analyzed data from 3,588 CHD patients who underwent PCI at TEDA International Cardiovascular Hospital between October 2016 and September 2017. The team tracked medication use for one year post-discharge and compared outcomes between patients who followed OMT (defined as dual antiplatelet therapy [DAPT], statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers [ACEIs/ARBs]) and those who did not.

How the Study Worked

Researchers used the hospital’s database to collect demographic and clinical details (age, weight, medical history, number of blocked arteries) and followed patients via outpatient visits or phone calls. They excluded people with drug allergies, terminal illnesses, kidney failure, or incomplete records. The primary goal was to assess whether OMT adherence was linked to fewer major adverse cardiovascular events (MACE)—including all-cause death, non-fatal heart attack, or stroke. Statistical models adjusted for factors like age, prior heart attacks, and baseline medication use to ensure results reflected OMT’s true impact.

Key Findings: Adherence Is Low, But Critical

At hospital discharge, most patients received OMT (58.8%), with nearly universal use of DAPT (99.6%)—a combination of aspirin and another antiplatelet drug to prevent blood clots—and statins (96.2%) to lower cholesterol. But by the one-year follow-up, adherence dropped sharply:

  • Only 36.2% of patients remained on all four OMT drugs.
  • Beta-blocker use (drugs that reduce heart strain and lower blood pressure) fell to under 60%.
  • ACEIs/ARBs (drugs that protect the heart and kidneys) dropped by nearly 30%.

The good news? Sticking to OMT paid off. Patients who followed the full regimen had a 62% lower risk of MACE compared to those who did not (hazard ratio [HR] 0.382, 95% confidence interval [CI] 0.244–0.599). Even individual drugs made a difference:

  • DAPT cut MACE risk by 88% (HR 0.122).
  • Statins reduced risk by 56% (HR 0.435).
  • Beta-blockers lowered risk by 39% (HR 0.614).
  • ACEIs/ARBs reduced risk by 57% (HR 0.433).

These results align with global research. The SYNTAX trial—a landmark study on revascularization—found that even five years after PCI, patients on OMT had fewer deaths and complications. Another trial (PREVENT IV) showed that combined medication use, not individual drugs, was key to reducing mortality or heart attacks.

Why This Matters

For CHD patients, PCI is life-saving—but it’s not a cure. OMT is the “follow-up” that keeps arteries healthy and prevents future events. The study highlights two critical issues:

  1. Adherence drops over time: Even though most patients start OMT in the hospital, many stop taking beta-blockers or ACEIs/ARBs within a year. Reasons may include side effects, cost, or not understanding the drugs’ importance.
  2. OMT works: Every part of the regimen contributes to better outcomes. Skipping one drug could mean missing out on critical protection.

Limitations to Consider

The study was conducted at a single hospital in China, so results may not apply to all populations. Drug use was self-reported (patients told researchers if they took their meds), which is less reliable than tracking prescription refills. The team also did not investigate why patients stopped OMT—whether it was a doctor’s advice, side effects, or forgetfulness.

The Takeaway

For CHD patients who’ve had PCI, OMT is a lifeline. Sticking to DAPT, statins, beta-blockers, and ACEIs/ARBs can drastically lower the risk of serious heart problems. For doctors, this means emphasizing the importance of long-term medication adherence—even when patients feel better. For health systems, it means finding ways to support patients (like reminders, cost assistance, or education) to stay on track.

This study was published in the Chinese Medical Journal in 2021 by Jing-Yan Hao, Jian Zhang, Rui Jing, Jing-Jing Liu, Cheng-Ye Di, Yu-Jie Lu, Peng Gao, Ya-Jie Wang, Rui-Fei Yang, and Wen-Hua Lin. The original research can be found at doi.org/10.1097/CM9.0000000000001720

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