Prognostic impact of guideline-directed medical therapy after functionally complete revascularisation in patients with obstructive coronary artery diseases

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OBJECTIVE: Functional complete revascularisation (FCR) has been proven to be associated with superior prognosis following percutaneous coronary intervention. Whether guideline-directed medical therapy (GDMT) still impacts clinical outcomes in patients who have achieved FCR requires further evaluation. METHODS: The study population was drawn from patients who achieved FCR in the FAVOR III China trial, defined as a quantitative flow ratio (QFR)-based residual functional Synergy between percutaneous coronary intervention with taxus and cardiac Surgery score of 0, measured only in vessels with QFR≤0.80. GDMT was defined as the combination of single or dual antiplatelet therapy, a beta-blocker and a statin, with or without an ACE inhibitor or angiotensin receptor blocker, according to contemporary guideline recommendations. Patients were categorised into the GDMT group (compliance with all 4 agents) or non-GDMT group (compliance with 0-3 agents). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 3 years, a composite of death, myocardial infarction, stroke and ischaemia-driven revascularisation. RESULTS: Among 3221 (85.2%) patients who achieved FCR, a total of 1964 (61.2%), 1919 (59.9%), 1545 (48.4%), 1483 (46.6%) and 1084 (35.3%) patients adhered to GDMT at 1 month, 6 months, 1 year, 2 years and 3 years, respectively. The MACCE occurred in 313 (10.2%) patients through 3 years. The rate of MACCE was similar between GDMT and non-GDMT groups within the first year, but significantly lower in the GDMT group from the second year (adjusted HR: 0.66, 95% CI: 0.51 to 0.85; p<0.01) and sustained until the third year (adjusted HR: 0.65, 95% CI: 0.50 to 0.85; p<0.01), compared with the non-GDMT group. CONCLUSIONS: In patients who achieved FCR, the benefit of good adherence to GDMT remained significant, starting from the second year and continuing up to 3 years. TRIAL REGISTRATION NUMBER: NCT03656848.

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