Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: https://twitter.com/HideyukiKawash2.
Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
J Am Coll Cardiol. 2021 Jul 6;78(1):27-38. doi: 10.1016/j.jacc.2021.04.087.
The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.
The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG.
This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial. OMT was defined as the combination of 4 types of medications: at least 1 antiplatelet drug, statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. After stratifying participants by the number of individual OMT agents at 5 years and randomized treatment, a landmark analysis was conducted to assess the association between treatment response and 10-year mortality.
In 1,472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on ≤2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; 95% CI: 0.292-0.757; P = 0.002) but had a mortality similar to those on 3 types of medications. Furthermore, patients undergoing CABG with the individual OMT agents, antiplatelet drug and statin, at 5 years had lower 10-year mortality than those without.
In patients with 3-vessel and/or left main disease undergoing percutaneous coronary intervention or CABG, medication status at 5 years had a significant impact on 10-year mortality. Patients on OMT with guideline-recommended pharmacologic therapy at 5 years had a survival benefit. (Synergy Between PCI With Taxus and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
在经皮冠状动脉介入治疗或冠状动脉旁路移植术（CABG）后，3 支血管病变和/或左主干病变患者接受最佳药物治疗（OMT）可改善 5 年结局，这在随机 SYNTAX（紫杉醇与心脏手术的协同作用）试验中得到了证实。
本分析旨在评估经皮冠状动脉介入治疗或 CABG 后 5 年 OMT 状态对 10 年死亡率的影响。
这是 SYNTAXES（紫杉醇与心脏手术延长生存的协同作用）研究的一项亚分析，该研究评估了最初纳入 SYNTAX 试验的患者最长 10 年的生存状况。OMT 定义为 4 种药物的联合应用：至少 1 种抗血小板药物、他汀类药物、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂。根据 5 年时 OMT 药物种类的数量对参与者进行分层，并根据随机治疗进行分层后，进行了一个 landmark 分析，以评估治疗反应与 10 年死亡率之间的关系。
在 1472 例患者中，5 年时接受 OMT 的患者 10 年死亡率显著低于接受≤2 种药物治疗的患者（13.1% vs. 19.9%；调整后的 HR：0.470；95%CI：0.292-0.757；P=0.002），但与接受 3 种药物治疗的患者死亡率相似。此外，5 年时接受 CABG 且单独使用 OMT 药物（抗血小板药物和他汀类药物）的患者 10 年死亡率低于未使用的患者。
在接受经皮冠状动脉介入治疗或 CABG 的 3 支血管和/或左主干病变患者中，5 年时的药物治疗状态对 10 年死亡率有显著影响。5 年时接受指南推荐的 OMT 药物治疗的患者有生存获益。（紫杉醇与心脏手术的协同作用：SYNTAX 延长生存 [SYNTAXES]；NCT03417050；紫杉醇药物洗脱支架与冠状动脉旁路移植术治疗狭窄动脉 [SYNTAX]；NCT00114972）。
