o:3213 Impact of optimal medical therapy on 10-year mortality after coronary revascularization en BACKGROUND: The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. OBJECTIVES: The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG. METHODS: This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial. OMT was defined as the combination of 4 types of medications: at least 1 antiplatelet drug, statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. After stratifying participants by the number of individual OMT agents at 5 years and randomized treatment, a landmark analysis was conducted to assess the association between treatment response and 10-year mortality. RESULTS: In 1,472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on #2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; 95% CI: 0.292-0.757; P 1⁄4 0.002) but had a mortality similar to those on 3 types of medications. Furthermore, patients undergoing CABG with the individual OMT agents, antiplatelet drug and statin, at 5 years had lower 10-year mortality than those without. CONCLUSIONS: In patients with 3-vessel and/or left main disease undergoing percutaneous coronary intervention or CABG, medication status at 5 years had a significant impact on 10-year mortality. Patients on OMT with guideline- recommended pharmacologic therapy at 5 years had a survival benefit. (Synergy Between PCI With Taxus and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972) Appendix: https://unilib.phaidrabg.rs/o:3213 Key words: coronary artery bypass graft, optimal medical therapy, percutaneous coronary intervention, survival, SYNTAX 91552100 128204297 1552101 0735-1097 1552099 10.1016/j.jacc.2021.04.087 2023-11-10T20:14:19.601Z 44 yes 46 Hideyuki Kawashima 46 Patrick W. Serruys 46 Masafumi Ono 46 Hironori Hara 46 Neil O'Leary 46 Michael J. Mack 46 David R. Holmes 46 Marie-Claude Morice 46 Stuart J. Head 46 Arie Pieter Kappetein 46 Daniel J.F.M. Thuijs 46 Milan Milojević 10616721 0000-0003-0984-9011 46 Thilo Noack 46 Friedrich-Wilhelm Mohr 46 Piroze M. Davierwala 46 Faisal Sharif 46 John W. McEvoy 46 Yoshinobu Onuma 46 SYNTAX Extended Survival Investigators institution application/pdf 620670 https://unilib.phaidrabg.rs/o:3213 no yes 1 70 616.12-089-036.8 92000001 71A11 Journal of the American College of Cardiology 78 1 27 38 2021