CBS 2019
CBSMD教育中心
中 文

科学研究

Abstract

Recommended Article

Patient Characteristics Associated With Antianginal Medication Escalation and De-Escalation Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN CTO Registry New AHA/ACC/HRS Guidance on Sudden Cardiac Death Prevention Ticagrelor versus Clopidogrel in Patients with STEMI Treated with Fibrinolytic Therapy: TREAT Trial A Combination of Allogeneic Stem Cells Promotes Cardiac Regeneration Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest Short Sleep Duration, Obstructive Sleep Apnea, Shiftwork, and the Risk of Adverse Cardiovascular Events in Patients After an Acute Coronary Syndrome Factors associated with pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) Association Between Collateral Circulation and Myocardial Viability Evaluated by Cardiac Magnetic Resonance Imaging in Patients With Coronary Artery Chronic Total Occlusion

Original Research2019 Apr 26;214:1-8.

JOURNAL:Am Heart J. Article Link

De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status

Qintar M, Hirai T, Salisbury AC et al. Keywords: antianginal medication; de-escalation; CTO; outcome; angina; dyspnea

ABSTRACT


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.

 

Copyright © 2019 Elsevier Inc. All rights reserved.