Key result
Optimal medical therapy remains underutilized in patients referred for PCI, although medication adherence appears significantly higher in patients treated with PCI than in those treated with OMT alone.
Despite guideline recommendations, optimal medical therapy remains underutilized in patients referred for PCI, emphasizing the need to prioritize medical therapy as the definitive treatment for stable angina.
WHAT IS KNOWN AND OBJECTIVE: Cardioprotective drug regimens improve outcomes in patients with stable coronary artery disease. Revascularization is recommended for the persistence of symptoms despite optimal medical therapy (OMT) or in patients likely to derive prognostic benefit. Our objective is to comment on recent evidence that initiation of OMT is suboptimal in patients undergoing percutaneous coronary intervention (PCI) but conversely adherence to medication may be higher in patients treated with PCI. COMMENT: Large randomized controlled trials demonstrate that the risk of death or myocardial infarction is similar in patients treated by OMT alone and those treated with PCI and OMT. Despite the recommendations of international practice guidelines, OMT remains underutilized in recent analyses of patients referred for PCI. Notwithstanding the underutilization of proven therapies, a recent study suggests that adherence to medication is significantly higher in patients treated with PCI than in those treated with OMT alone. We discuss the potential factors that may contribute to underprescription of OMT and predict adherence in patients undergoing PCI. WHAT IS NEW AND CONCLUSION: Contemporary studies continue to demonstrate underutilization of OMT in patients referred for PCI but increased medication adherence in patients treated by PCI. We argue for increased recognition of OMT as the definitive treatment for stable angina, so that we can be sure those patients who require PCI 'are taking' and 'keep taking' the tablets.
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Mohee et al. (2014) conducted a review in Stable coronary artery disease / Stable angina. Optimal medical therapy (OMT) and percutaneous coronary intervention (PCI) vs. OMT alone was evaluated. Optimal medical therapy remains underutilized in patients referred for PCI, although medication adherence appears significantly higher in patients treated with PCI than in those treated with OMT alone.
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