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Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization with Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Insights from the SYNTAX Trial at 5-Year Follow-Up

Monday, March 16, 2015

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Iqbal J, Zhang Y-J, Holmes DR, Morice M-C, Mack MJ, Kappetein AP, Feldman T, Escaned J, Stahle E, Banning AP, Gunn JP, Colombo A, Steyerberg EW, Mohr FW, Serruys PW

In this manuscript the authors present a post-hoc study of the SYNTAX trial. They compare outcomes between those patients on optimal medical therapy (OMT) and non-optimal medical therapy following revascularization for complex coronary artery disease (CAD). OMT was defined as combination of at least one antiplatelet drug, statin, beta-blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB). Only one third of the patients were found to be on OMT at 5-year follow up. Lack of OMT was associated with a higher mortality and combined endpoint of death, MI and stroke. These findings reinforce the the importance of OMT use for patients with complex CAD undergoing revascularization.


Also add to that sesation of smoking and good control of blood pressure and diabetes
The concept of OMT after either PCI or CABG of SYNTAX patients seems to be a bit confusing. If one thoroughly scrutinize the CABG arm of the Syntax study would quickly discover, that a great proportion of TVD or LM patients in fact have LVF well above 50%, no previous MI and lack of history of hypertension. My question is : patients after complete arterial revascularization with unharmed left ventricle, no hypertension why should be put on the defined OMT? Apart from baby Aspirin... Statins really would not help - especially not in patients with no high LDL and triglycerides. Is this something to do with the pharmaceutical industry?
Dear colleagues,I used to put my post CABGs patients systematically on dual antiplatelet therapy(aspirine and clopidogrel) for one year than aspirine alone,add to this a high potent statine(atorva or rosuva),ramipril or telmisartan,with recently trimetazidine(3-6 mnths)... We know that atherodisease is a continuos and nonstop disease,so whatever is the revasc. technic ,i think it s advisable to go that way of OMT and protect ur patients more and more... Thanks..

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