Association of guideline-directed medical therapy adherence with outcomes after fractional flow reserve-based deferral of revascularization

Author:

Ishii Masanobu1,Kuramitsu Shoichi2ORCID,Yamanaga Kenshi1,Matsuo Hitoshi3,Horie Kazunori4,Takashima Hiroaki5,Terai Hidenobu6,Kikuta Yuetsu7,Ishihara Takayuki8,Saigusa Tatsuya9,Sakamoto Tomohiro10,Suematsu Nobuhiro11,Shiono Yasutsugu12,Asano Taku13,Masamura Katsuhiko14,Doijiri Tatsuki15,Toyota Fumitoshi16,Ogita Manabu17ORCID,Kurita Tairo18,Matsuo Akiko19,Harada Ken20,Yaginuma Kenji21,Kanemura Noriyoshi22,Sonoda Shinjo23,Yokoi Hiroyoshi24,Tanaka Nobuhiro25,Tsujita Kenichi1ORCID,Takashima Hiroaki,Ohashi Hirofumi,Toyota Fumitoshi,Sasaki Yohei,Harada Ken,Yokoi Hiroyoshi,Yamamoto Yasunori,Kikuta Yuetsu,Hirabayashi Mika,Matsuo Hitoshi,Kikuchi Jun,Itakura Ryosuke,Matsuo Akiko,Suwa Satoru,Ogita Manabu,Yokoyama Ken,Yaginuma Kenji,Isogai Hiroyuki,Yamada Takashi,Kanemura Noriyoshi,Terai Hidenobu,Iida Osamu,Ishihara Takayuki,Tsujita Kenichi,Yamanaga Kenshi,Ishii Masanobu,Kuramitsu Shoichi,Kurita Tairo,Masamura Katsuhiko,Kanehachi Masanori,Niwa Toru,Yamaki Masaru,Suematsu Nobuhiro,Sakamoto Tomohiro,Kodama Kazuhisa,Horie Kazunori,Saigusa Tatsuya,Ueki Yasushi,Senda Keisuke,Mizuno Atsushi,Asano Taku,Kato Daiki,Tanaka Nobuhiro,Yamashita Jun,Sonoda Shinjo,Anai Reo,Shiono Yasutsugu,Doijiri Tatsuki,

Affiliation:

1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , 1 Chome 1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan

2. Department of Cardiology, Kokura Memorial Hospital , 3 Chome-2-1 Asano, Kokurakita Ward, Kitakyushu 802-8555, Japan

3. Department of Cardiovascular Medicine, Gifu Heart Center , 4 Chome-14-4, Yabuta-minami, Gifu City, Gifu 500-8384, Japan

4. Department of Cardiovascular Medicine, Sendai Kousei Hospital , 4-15 Hirosemachi, Aoba Ward, Sendai 980-0873, Japan

5. Department of Cardiology, Aichi Medical University , 1-1 Yazakokarimata, Nagakute 480-1195, Japan

6. Department of Cardiology, Kanazawa Cardiovascular Hospital , Ha−16 Tanakamachi, Kanazawa 920-0007, Japan

7. Department of Cardiology, Fukuyama Cardiovascular Hospital , 2−39 Midorimachi, Fukuyama 720-0804, Japan

8. Kansai Rosai Hospital Cardiovascular Center , 3-chōme-1-69 Inabasō, Amagasaki 660-8511, Japan

9. Department of Cardiovascular Medicine, Shinshu University School of Medicine , 3 Chome-1-1 Asahi, Matsumoto 390-8621, Japan

10. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center , 5 Chome-3 No. 1 Chikami, Minami Ward, Kumamoto 861-4193, Japan

11. Department of Cardiology, Saiseikai Fukuoka General Hospital , 1 Chome-3-46 Tenjin, Fukuoka 810-0001, Japan

12. Department of Cardiovascular Medicine, Wakayama Medical University , 811-1 Kimiidera, Wakayama 641-8509, Japan

13. Department of Cardiology, St Luke's International Hospital , 9-1 Akashicho, Chuo City Tokyo 104-8560, Japan

14. Department of Cardiology, Nakamura Hospital , 4-28 Tennocho, Echizen  915-0068, Japan

15. Department of Cardiology, Yamato Seiwa Hospital , 9 Chome-8-2 Minamirinkan, Yamato 242-0006, Japan

16. Department of Cardiology, Chidoribashi Hospital , 5-18-1 Chiyo, Fukuoka 812-8633, Japan

17. Department of Cardiology, Juntendo University Shizuoka Hospital , 1129 Nagaoka, Shizuoka 410-2295, Japan

18. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine , 2 Chome-174, Mie 514-8507, Japan

19. Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital , Higashiuratsujicho, Kamigyo Ward, Kyoto 602-8031, Japan

20. Department of Cardiology, Chubu Rosai Hospital , 1-10-6 Komei, Minato Ward, Nagoya 455-8530, Japan

21. Department of Cardiology, Juntendo University Urayasu Hospital , 2 Chome-1-1 Tomioka, Chiba 279-0021, Japan

22. Department of Cardiology, Kainan hospital , Minamihonden-396 Maegasucho, Aichi 498-8502, Japan

23. Department of Cardiovascular Failure Therapy, Saga University , 5-1-1, Nabeshima 849-8501, Japan

24. Department of Cardiology, Fukuoka Sanno Hospital , 3-6-45 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan

25. Department of Cardiology, Tokyo Medical University Hachioji Medical Center , 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan

Abstract

Abstract Aims Guideline-directed medical therapy (GDMT) is essential to prevent future cardiovascular events in chronic coronary syndrome (CCS) patients. However, whether achieving optimal GDMT could improve clinical outcomes in CCS patients with deferred lesions based on fraction flow reserve (FFR) remains thoroughly investigated. We sought to evaluate the association of GDMT adherence with long-term outcomes after FFR-based deferral of revascularization in a real-world registry. Methods and results This is a post-hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicentre registry). Optimal GDMT was defined as combining four types of medications: antiplatelet drug, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, beta-blocker, and statin. After stratifying patients by the number of individual GDMT agents at 2 years, landmark analysis was conducted to assess the relationship between GDMT adherence at 2 years and 5-year major adverse cardiac events (MACEs), defined as a composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization. Compared with the suboptimal GDMT group (continuing ≤3 types of medications, n = 974), the optimal GDMT group (n = 139) showed a lower 5-year incidence of MACE (5.2% vs. 12.4%, P = 0.02). The optimal GDMT was associated with a lower risk of MACE (hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.92; P = 0.03). Conclusion Patients with optimal GDMT were associated with better outcomes, suggesting the importance of achieving optimal GDMT on long-term prognosis in CCS patients after FFR-guided deferral of revascularization.

Funder

Abbott Medical Japan

Boston Scientific Japan

Philips Japan

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Cardiology and Cardiovascular Medicine

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