De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status.
Am Heart J
; 214: 1-8, 2019 08.
Article
in En
| MEDLINE
| ID: mdl-31152872
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 6â¯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 1â¯month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6â¯months compared with those whose AAMs were reduced (any angina 22.5% vs 20%, Pâ¯=â¯.43; any dyspnea 51.8% vs 50.1%, Pâ¯=â¯.40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1â¯month was not associated with an increased risk of angina, dyspnea, or worse health status at 6â¯months.CONCLUSIONS:
Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1â¯month and was not associated with worse long-term health status.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiovascular Agents
/
Health Status
/
Coronary Occlusion
/
Percutaneous Coronary Intervention
/
Angina Pectoris
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
Am Heart J
Year:
2019
Type:
Article
Affiliation country:
Macao