De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status - 14/07/19
Résumé |
Background |
Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status.
Methods |
In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation.
Results |
Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months.
Conclusions |
Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.
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| Key points Question: Can antianginal medications (AAMs) be de-escalated early after successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) without worsening health status outcomes? Findings: In a large US CTO PCI registry, patients whose AAMs were de-escalated reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were not reduced. In a multivariable model, early de-escalation of AAMs was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. Meaning: Among patients with successful CTO PCI, early de-escalation of AAMs can be considered and appears to be safe. |
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| Funding sources. This project was funded by an unrestricted grant from Gilead Sciences. Dr Qintar is supported by The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837. OPEN CTO registry was funded by unrestricted grant support from Boston Scientific. All data collection, data analyses, the preparation of the manuscript, and the decision to submit the manuscript for publication were conducted independently of the study sponsors. |
Vol 214
P. 1-8 - août 2019 Retour au numéro
Article précédent
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