Borden, MD, of Weill Cornell Medical College, Cornell University, New York, and colleagues conducted a study to examine the use of the WTO, before and after PCI, and to evaluate whether the use of OMT changed after the publication of the COURAGE study (March 2007). The study included data from the National Register of cardiovascular data of patients with stable coronary artery disease undergoing PCI between September 2005 and June 2009. Comparative analysis with OMT before PCI and at discharge, and before and after the publication of the COURAGE study. Optimal medical therapy was defined as an indication prescribed or have documented all the counter-drugs (antiplatelet agents and statins).“Our study showed that less than half of patients undergoing PCI are taking OMT before their procedure, despite the recommendations of the guidelines based on maximizing the WTO and the logic to the clinic before PCI so that the need for relief of symptoms of additional revascularization can be enjoyed. Even after the publication of the COURAGE study, little change in practice this pattern has been observed. Although doctors have increased the use of OMT before discharge, antiplatelet be almost universally applied almost one third of patients were not treated with OMT, a model that n is not changed after the COURAGE trial was published. Collectively, these results suggest significant opportunities for improvement and a limited effect on a costly clinical trial of high-profile on routine clinical practice, “the authors write.
The researchers found that 206 569 patients (44.2 percent) received OMT before PCI 864 and 303 patients (65 percent) received OMT at discharge. “Before the COURAGE trial, the rate of the WTO, at the time of PCI was 43.5 percent. Although the increase in the proportion of patients treated with OMT before PCI after COURAGE trial was significantly higher, there was little clinical significance (131,188 patients [44.7 percent]). The rates of this goal by the PCI in each study month showed a slight increase over the 46 months of observation, with a rate of OMT before PCI of 43, 4 percent in September 2005 and a rate of OMT after ICP 45.0 percent in June 2009, “the authors write.
Although PCI may improve outcomes for patients with acute coronary syndrome, OMT results in similar rates of cardiovascular events than PCI in patients with stable coronary artery disease (CAD). The results of a meta-analysis of 11 studies concluded that there was no benefit of PCI in preventing or death in patients with stable coronary artery disease. In addition, the clinical use of revascularization and aggressive drug evaluation (Courage) study, which the WTO has provided to all patients, showed no benefit of PCI on outcomes other than angina, chest-related quality of life in stable coronary artery disease, suggesting that the process of OMT is warranted before PCI. “It is not known to what extent the WTO is applied before PCI in routine practice, or if its use increased after the COURAGE trial,” according to background information in the article.