Optimal Medical Therapy Often Not Applied Before PCI

Less than half of stable angina patients receive OMT before percutaneous coronary intervention

TUESDAY, May 10 (HealthDay News) -- Less than half the patients with stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) receive optimal medical therapy (OMT) before PCI; whereas, approximately two-thirds receive it following PCI, with similar practice patterns seen before and after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, according to a study published in the May 11 issue of the Journal of the American Medical Association.

William B. Borden, M.D., from Cornell University in New York City, and colleagues examined the use of OMT (defined as being prescribed or having a documented contraindication to all medicines [antiplatelet agent, β-blocker, and statin]) in 467,211 patients with CAD, before and after undergoing PCI between 2005 and 2009. OMT use was also compared in the 173,416 patients before and 293,795 patients after the publication of the COURAGE trial.

The investigators found that OMT was used in 44.2 percent of patients before PCI and in 65.0 percent after PCI. Before patients underwent PCI, OMT was used in a similar percentage of patients before and after the COURAGE trial (43.5 and 44.7 percent, respectively). At discharge following PCI, OMT was used in 63.5 and 66.0 percent of patients before and after the COURAGE trial, respectively.

"Our study demonstrated that less than half of patients undergoing PCI are taking OMT before their procedure, despite the guideline-based recommendations to maximize OMT and the clinical logic of doing so before PCI so that the need for additional symptom relief from revascularization can be appreciated," the authors write.

One of the study authors disclosed a financial tie with the medical device industry.

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