CABG may outperform PCI in patients with suboptimal medication adherence
medwireNews: The risk of major adverse cardiac events (MACE) may be lower in patients undergoing coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) among those who do not adhere to recommended medical therapy, study results suggest.
In a retrospective analysis, Paul Kurlansky (Columbia University, New York, USA) and colleagues found that patients who adhered to their prescribed medication following coronary revascularization were more than twice as likely to experience MACE-free survival compared with those who were nonadherent to therapy (hazard ratio=2.79). The beneficial effect of medication adherence was observed in both the CABG and PCI groups.
However, among patients not following the recommended medical treatment, those who underwent CABG were significantly less likely to experience MACE than those who underwent PCI.
“[A]mong patients who might be anatomically suitable for either approach, for those who are unlikely to accept to rigors of careful medical therapy, CABG may be preferable to PCI,” write the study authors.
As reported in Circulation, data from 973 CABG and 2255 PCI patients were analyzed from the CARE registry; median follow-up times were 84.0 and 79.4 months, respectively. MACE were defined as mortality, nonfatal myocardial infarction or any repeat revascularization procedure. Optimal medical treatment included antiplatelet, lipid-lowering or beta-blocker therapy.
When nonadherent patients in the CABG and PCI groups were matched according to risk profile, approximately 25% of CABG patients experienced MACE during follow-up, compared with approximately 35% of PCI patients. A similar benefit of CABG over PCI was not observed in those adhering to recommended treatment.
Kurlansky and colleagues urge caution given that the study was limited by a number of factors, including self-reported medication history.
“[The findings] are based on retrospective data derived from subgroup analyses of limited numbers of patients and can best be viewed as hypothesis generating,” they write.
They add that “more careful, longer-term studies” should be conducted in a “larger, more contemporary patient population” to test whether adherence to medical therapy has an effect on the relative benefits of CABG and PCI.
“We know enough from this study to seriously ask the question – are patients unwilling to adhere to medication schedules better off choosing heart bypass over angioplasty – but the answer needs to come from larger more contemporary trials,” explained Kurlansky in a press release.
The authors conclude: “Knowledge of the relative effect of medication adherence can be extremely important in clinical decision making and should be addressed in all future comparative studies of [coronary artery revascularization] strategies.”
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