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Contrary to clinical practice guidelines and simple logic, most patients who have stable coronary artery disease are not given optimal medical therapy before undergoing percutaneous coronary intervention, according to a recent study reported in JAMA.
In March 2007, "the most definitive randomized trial" comparing percutaneous coronary intervention (PCI) to optimal medical therapy, determined that PCI is no more effective than drug treatment at preventing MI or death in stable CAD. But even with this evidence, there was little change in the pattern of stable CAD patients going straight to PCI, said Dr. William B. Borden of Weill Cornell Medical College in New York, and his associates.
Dr. Borden and his colleagues assessed the practice patterns regarding the use of optimal medical therapy before and after PCI using data obtained from the national CathPCI Registry.
The researchers examined a 19-month interval occurring before publication of the trial results of Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) (N. Engl. J. Med. 2007;356:1503-16) and a 24-month period occuring afterward, to determine whether physicians had been inspired to transfer those findings into clinical practice.
The study population comprised 467,211 patients treated at 1,013 U.S. hospitals, which constituted about 28% of the total CathPCI population during the study period.
Optimal medical therapy was defined as being prescribed aspirin, a beta-blocker, and a statin before PCI and being prescribed aspirin or thienopyridine, a beta-blocker, a statin, and an ACE inhibitor or angiotensin receptor blocker after PCI, or having specific contraindications to these medications.
Overall, fewer than half of PCI patients ? 45% ? received optimal medical therapy before undergoing PCI. Current guidelines recommend maximizing medical therapy because that often relieves symptoms, obviating the need for PCI.
The rates of optimal medical therapy increased only slightly after publication of the COURAGE results, from 43% to 45%. This increase "was of little clinical significance," the investigators said (JAMA 2011:305:1882-9).
Dr. Borden disclosed ties to the pharmaceutical Kowa Company.
Contrary to clinical practice guidelines and simple logic, most patients who have stable coronary artery disease are not given optimal medical therapy before undergoing percutaneous coronary intervention, according to a recent study reported in JAMA.
In March 2007, "the most definitive randomized trial" comparing percutaneous coronary intervention (PCI) to optimal medical therapy, determined that PCI is no more effective than drug treatment at preventing MI or death in stable CAD. But even with this evidence, there was little change in the pattern of stable CAD patients going straight to PCI, said Dr. William B. Borden of Weill Cornell Medical College in New York, and his associates.
Dr. Borden and his colleagues assessed the practice patterns regarding the use of optimal medical therapy before and after PCI using data obtained from the national CathPCI Registry.
The researchers examined a 19-month interval occurring before publication of the trial results of Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) (N. Engl. J. Med. 2007;356:1503-16) and a 24-month period occuring afterward, to determine whether physicians had been inspired to transfer those findings into clinical practice.
The study population comprised 467,211 patients treated at 1,013 U.S. hospitals, which constituted about 28% of the total CathPCI population during the study period.
Optimal medical therapy was defined as being prescribed aspirin, a beta-blocker, and a statin before PCI and being prescribed aspirin or thienopyridine, a beta-blocker, a statin, and an ACE inhibitor or angiotensin receptor blocker after PCI, or having specific contraindications to these medications.
Overall, fewer than half of PCI patients ? 45% ? received optimal medical therapy before undergoing PCI. Current guidelines recommend maximizing medical therapy because that often relieves symptoms, obviating the need for PCI.
The rates of optimal medical therapy increased only slightly after publication of the COURAGE results, from 43% to 45%. This increase "was of little clinical significance," the investigators said (JAMA 2011:305:1882-9).
Dr. Borden disclosed ties to the pharmaceutical Kowa Company.
Contrary to clinical practice guidelines and simple logic, most patients who have stable coronary artery disease are not given optimal medical therapy before undergoing percutaneous coronary intervention, according to a recent study reported in JAMA.
In March 2007, "the most definitive randomized trial" comparing percutaneous coronary intervention (PCI) to optimal medical therapy, determined that PCI is no more effective than drug treatment at preventing MI or death in stable CAD. But even with this evidence, there was little change in the pattern of stable CAD patients going straight to PCI, said Dr. William B. Borden of Weill Cornell Medical College in New York, and his associates.
Dr. Borden and his colleagues assessed the practice patterns regarding the use of optimal medical therapy before and after PCI using data obtained from the national CathPCI Registry.
The researchers examined a 19-month interval occurring before publication of the trial results of Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) (N. Engl. J. Med. 2007;356:1503-16) and a 24-month period occuring afterward, to determine whether physicians had been inspired to transfer those findings into clinical practice.
The study population comprised 467,211 patients treated at 1,013 U.S. hospitals, which constituted about 28% of the total CathPCI population during the study period.
Optimal medical therapy was defined as being prescribed aspirin, a beta-blocker, and a statin before PCI and being prescribed aspirin or thienopyridine, a beta-blocker, a statin, and an ACE inhibitor or angiotensin receptor blocker after PCI, or having specific contraindications to these medications.
Overall, fewer than half of PCI patients ? 45% ? received optimal medical therapy before undergoing PCI. Current guidelines recommend maximizing medical therapy because that often relieves symptoms, obviating the need for PCI.
The rates of optimal medical therapy increased only slightly after publication of the COURAGE results, from 43% to 45%. This increase "was of little clinical significance," the investigators said (JAMA 2011:305:1882-9).
Dr. Borden disclosed ties to the pharmaceutical Kowa Company.