This report evaluates the impact of guideline-directed medical therapy (GDMT) on clinical outcomes in patients who achieved functional complete revascularization (FCR) following percutaneous coronary intervention (PCI). FCR, defined by a zero residual functional SYNTAX score based on quantitative flow ratio (QFR), is associated with improved prognosis. However, the influence of continued medical therapy in these patients warrants investigation.
The study analyzed data from the FAVOR III China trial, focusing on patients with FCR. GDMT was characterized by the use of antiplatelet agents (single or dual therapy), beta-blockers, and statins, with optional ACE inhibitors or angiotensin receptor blockers, aligned with current guidelines. Patients were divided into two groups: those adhering to all four medication classes (GDMT group) and those adhering to fewer (non-GDMT group). The primary outcome assessed was major adverse cardiac and cerebrovascular events (MACCE)—a composite of death, myocardial infarction, stroke, and ischemia-driven revascularization—over three years.
Of 3,221 patients achieving FCR, approximately 85% (2,742) maintained this status. Medication adherence declined over time, with 61.2% at 1 month and dropping to 35.3% at 3 years. During follow-up, 10.2% experienced MACCE. The analysis revealed no significant difference in MACCE rates between groups within the first year. However, from the second year onward, patients adhering to GDMT exhibited a significantly lower risk of adverse events (adjusted hazard ratio [HR]: 0.66; 95% confidence interval [CI]: 0.51–0.85; p<0.01), and this benefit persisted through year three (adjusted HR: 0.65; 95% CI: 0.50–0.85; p<0.01).
In conclusion, for patients who achieved FCR, sustained adherence to GDMT provided a significant reduction in adverse cardiovascular events beginning after the first year and lasting up to three years. These findings underscore the importance of ongoing guideline-based medical therapy even after complete revascularization.
Reference:
Geng Y, Guan C, Jiang Y, Yang W, Yu B, Fu G, Pu J, Qu X, Zhang Q, Zhao Y, Yu L, Huang Y, Tu S, Qiao S, Song L. Prognostic impact of guideline-directed medical therapy after functionally complete revascularisation in patients with obstructive coronary artery diseases. Heart. 2026 Feb 12;112(5):270-277. doi: 10.1136/heartjnl-2025-325670. PMID: 40780826.
