Association of guideline-directed medical therapy adherence with outcomes after fractional flow reserve-based deferral of revascularization
Authors: Ishii Masanobu , Kuramitsu Shoichi , Yamanaga Kenshi , Matsuo Hitoshi , Horie Kazunori , Takashima Hiroaki , Terai Hidenobu , Kikuta Yuetsu , Ishihara Takayuki , Saigusa Tatsuya , Sakamoto Tomohiro , Suematsu Nobuhiro , Shiono Yasutsugu , Asano Taku , Masamura Katsuhiko , Doijiri Tatsuki , Toyota Fumitoshi , Ogita Manabu , Kurita Tairo , Matsuo Akiko , Harada Ken , Yaginuma Kenji , Kanemura Noriyoshi , Sonoda Shinjo , Yokoi Hiroyoshi , Tanaka Nobuhiro , Tsujita Kenichi ,   The J- CONFIRM Registry Investigators, Takashima Hiroaki , Ohashi Hirofumi , Toyota Fumitoshi , Sasaki Yohei , Harada Ken , Yokoi Hiroyoshi , Yamamoto Yasunori , Kikuta Yuetsu , Hirabayashi Mika , Matsuo Hitoshi , Kikuchi Jun , Itakura Ryosuke , Matsuo Akiko , Suwa Satoru , Ogita Manabu , Yokoyama Ken , Yaginuma Kenji , Isogai Hiroyuki , Yamada Takashi , Kanemura Noriyoshi , Terai Hidenobu , Iida Osamu , Ishihara Takayuki , Tsujita Kenichi , Yamanaga Kenshi , Ishii Masanobu , Kuramitsu Shoichi , Kurita Tairo , Masamura Katsuhiko , Kanehachi Masanori , Niwa Toru , Yamaki Masaru , Suematsu Nobuhiro , Sakamoto Tomohiro , Kodama Kazuhisa , Horie Kazunori , Saigusa Tatsuya , Ueki Yasushi , Senda Keisuke , Mizuno Atsushi , Asano Taku , Kato Daiki , Tanaka Nobuhiro , Yamashita Jun , Sonoda Shinjo , Anai Reo , Shiono Yasutsugu , Doijiri Tatsuki 
Published: January 2022

Abstract

Aims
Guideline-directed medical therapy (GDMT) is essential to prevent future cardiovascular events in chronic coronary syndrome (CCS) patients. However, whether achieving optimal GDMT could improve clinical outcomes in CCS patients with deferred lesions based on fraction flow reserve (FFR) remains thoroughly investigated. We sought to evaluate the association of GDMT adherence with long-term outcomes after FFR-based deferral of revascularization in a real-world registry.

Methods and results
This is a post-hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicentre registry). Optimal GDMT was defined as combining four types of medications: antiplatelet drug, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, beta-blocker, and statin. After stratifying patients by the number of individual GDMT agents at 2 years, landmark analysis was conducted to assess the relationship between GDMT adherence at 2 years and 5-year major adverse cardiac events (MACEs), defined as a composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization. Compared with the suboptimal GDMT group (continuing ≤3 types of medications, n = 974), the optimal GDMT group (n = 139) showed a lower 5-year incidence of MACE (5.2% vs. 12.4%, P = 0.02). The optimal GDMT was associated with a lower risk of MACE (hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.92; P = 0.03).

Conclusion
Patients with optimal GDMT were associated with better outcomes, suggesting the importance of achieving optimal GDMT on long-term prognosis in CCS patients after FFR-guided deferral of revascularization.