Compliance With Guideline-Directed Medical Therapy in Contemporary Coronary Revascularization Trials

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Pinho Gomes, AC (Author) Other; Azevedo L (Author) FMUP; Ahn, JM (Author) Other; Park, SJ (Author) Other; Hamza, TH (Author) Other; Farkouh, ME (Author) Other; Serruys, PW (Author) Other; Milojevic, M (Author) Other; Kappetein, AP (Author) Other; Stone, GW (Author) Other; Lamy, A (Author) Other; Fuster, V (Author) Other; Taggart, DP (Author) Other

Journal

Title: Journal of the American College of Cardiology

Vol. 71

Pages: 591-602

ISSN: 0735-1097

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 90 Citations

Scopus - 94 Citations

Other information

Authenticus ID: P-00N-KN6

DOI: 10.1016/j.jacc.2017.11.068

Abstract (EN): BACKGROUND Despite the well-established benefits of secondary cardiovascular prevention, the importance of concurrent medical therapy in clinical trials of coronary revascutarization is often overlooked.& para;& para;OBJECTIVES The goat of this study was to assess compliance with guideline-directed medical therapy (GDMT) in clinical trials and its potential impact on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).& para;& para;METHODS The Cochrane Central Register of Controlled Trials and MEDLINE were searched from 2005 to August 2017. Clinical trial registries and reference lists of relevant studies were also searched. Randomized controlled trials comparing PO with drug-eluting stents versus CABG and reporting medical therapy after revascutarization were included. The study outcome was compliance with GDMT, defined as the following: 1) any antiplatelet agent plus beta-blocker plus statin (GDMT1); and 2) any antiplatelet agent plus beta-btocker plus statin plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (GDMT2). Data collection and analysis were performed according to the methodological recommendations of The Cochrane Collaboration.& para;& para;RESULTS From a total of 439 references, 5 trials were included based on our inclusion and exclusion criteria. Overall, compliance with GDMT1 was low and decreased over time from 67% at 1 year to 53% at 5 years. Compliance with GDMT2 was even lower and decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1 and GDMT2 was higher in PCI than in CABG at all time points. Meta-regression suggested an association between tower use of GDMT1 and adverse dinical outcomes in PCI versus CABG at 5 years.& para;& para;CONCLUSIONS Compliance with GDMT in contemporary clinical trials remains suboptimal and is significantly lower after CABG than after PO, which may influence the comparison of dinical trial endpoints between those study groups. (C) 2018 by the American College of Cardiology Foundation.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 12