Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting: Insights from the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up

Iqbal Javaid, Zhang Yao-Jun, David R. Holmes, Marie Claude Morice, Michael J. Mack, Arie Pieter Kappetein, Feldman Ted, Stahle Elizabeth, Escaned Javier, Adrian P. Banning, Julian P. Gunn, Antonio Colombo, Ewout W. Steyerberg, Friedrich W. Mohr, Patrick W. Serruys

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background - There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results - The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions - The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

Original languageEnglish
Pages (from-to)1269-1277
Number of pages9
JournalCirculation
Volume131
Issue number14
DOIs
Publication statusPublished - 2015

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Thoracic Surgery
Therapeutics
Coronary Disease
Mortality
Confidence Intervals
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Patient Discharge
Angiotensin Receptor Antagonists
Platelet Aggregation Inhibitors
Angiotensin-Converting Enzyme Inhibitors
Coronary Artery Disease
Randomized Controlled Trials
History
Stroke
Myocardial Infarction

Keywords

  • Coronary artery bypass
  • Coronary artery disease
  • Stents

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting : Insights from the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. / Javaid, Iqbal; Yao-Jun, Zhang; Holmes, David R.; Morice, Marie Claude; Mack, Michael J.; Kappetein, Arie Pieter; Ted, Feldman; Elizabeth, Stahle; Javier, Escaned; Banning, Adrian P.; Gunn, Julian P.; Colombo, Antonio; Steyerberg, Ewout W.; Mohr, Friedrich W.; Serruys, Patrick W.

In: Circulation, Vol. 131, No. 14, 2015, p. 1269-1277.

Research output: Contribution to journalArticle

Javaid, Iqbal ; Yao-Jun, Zhang ; Holmes, David R. ; Morice, Marie Claude ; Mack, Michael J. ; Kappetein, Arie Pieter ; Ted, Feldman ; Elizabeth, Stahle ; Javier, Escaned ; Banning, Adrian P. ; Gunn, Julian P. ; Colombo, Antonio ; Steyerberg, Ewout W. ; Mohr, Friedrich W. ; Serruys, Patrick W. / Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting : Insights from the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up. In: Circulation. 2015 ; Vol. 131, No. 14. pp. 1269-1277.
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abstract = "Background - There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results - The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95{\%} confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95{\%} confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36{\%} relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26{\%} relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions - The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.",
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author = "Iqbal Javaid and Zhang Yao-Jun and Holmes, {David R.} and Morice, {Marie Claude} and Mack, {Michael J.} and Kappetein, {Arie Pieter} and Feldman Ted and Stahle Elizabeth and Escaned Javier and Banning, {Adrian P.} and Gunn, {Julian P.} and Antonio Colombo and Steyerberg, {Ewout W.} and Mohr, {Friedrich W.} and Serruys, {Patrick W.}",
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T1 - Optimal medical therapy improves clinical outcomes in patients undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting

T2 - Insights from the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) trial at the 5-year follow-up

AU - Javaid, Iqbal

AU - Yao-Jun, Zhang

AU - Holmes, David R.

AU - Morice, Marie Claude

AU - Mack, Michael J.

AU - Kappetein, Arie Pieter

AU - Ted, Feldman

AU - Elizabeth, Stahle

AU - Javier, Escaned

AU - Banning, Adrian P.

AU - Gunn, Julian P.

AU - Colombo, Antonio

AU - Steyerberg, Ewout W.

AU - Mohr, Friedrich W.

AU - Serruys, Patrick W.

PY - 2015

Y1 - 2015

N2 - Background - There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results - The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions - The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

AB - Background - There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results - The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions - The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

KW - Coronary artery bypass

KW - Coronary artery disease

KW - Stents

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