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Medical Therapy after Successful Percutaneous Coronary Revascularization

David Hasdai, MD; Amir Lerman, MD; Diane E. Grill, MS; Charanjit S. Rihal, MD; and David R. Holmes Jr., MD
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From the Mayo Clinic, Rochester, Minnesota.

Ann Intern Med. 1999;130(2):108-115. doi:10.7326/0003-4819-130-2-199901190-00004
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Background: Percutaneous coronary revascularization frequently relieves angina in patients with ischemic heart disease and may obviate the need for antianginal medications.

Objective: To examine the use of antianginal medications after successful percutaneous coronary revascularization.

Design: Retrospective cohort study of the Mayo Clinic PTCA [percutaneous transluminal coronary angioplasty] Registry.

Setting: Tertiary care center.

Patients: 3831 patients who underwent successful percutaneous coronary revascularization from September 1979 through August 1997 and had not had myocardial infarction within the year before the intervention.

Measurements: Use of antianginal medications (β-adrenergic blockers, nitrates, and calcium-channel blockers) before the intervention, at hospital discharge, and 6 months after the intervention.

Results: 99% of patients reported improvement in their symptoms at hospital discharge. At 6 months, 87% of patients were free of myocardial infarction, coronary bypass surgery, or additional percutaneous intervention. Compared with 66% of patients before the index intervention, only 12% of patients had severe angina at 6 months and 69% were completely free of angina. Nonetheless, at 6 months, 39% of patients were receiving β-adrenergic blockers (preprocedure proportion, 43%; P < 0.001), 36% were receiving nitrates (preprocedure proportion, 41%; P < 0.001), and 57% were receiving calcium-channel blockers (preprocedure proportion, 50%; P < 0.001). These trends persisted for patients without hypertension and those who had complete revascularization.

Conclusions: Successful percutaneous coronary revascularization did not substantially supplant the use of antianginal medications, which were commonly used despite the marked improvement in anginal status. This may reflect reluctance to alter therapy once symptoms of angina subside. Guidelines on continued medical therapy after percutaneous coronary revascularization are needed.





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