Medical therapy after successful percutaneous coronary revascularization

Background: Percutaneous coronary revascularization frequently relieves ang ina in patients with ischemic heart disease and may obviate the need for an tianginal medications. Objective: To examine the use of antianginal medications after successful p ercutaneous coronary revascularization. Design: Retrospective cohort study of the Mayo Clinic PTCA [percutaneous tr ansluminal coronary angioplasty] Registry. Setting: Tertiary care center. Patients: 3831 patients who underwent successful percutaneous coronary reva scularization from September 1979 through August 1997 and had not had myoca rdial infarction within the year before the intervention. Measurements: Use of antianginal medications (beta-adrenergic blockers, nit rates, and calcium-channel blockers) before the intervention, at hospital d ischarge, 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. Co mpa red with 66% of patients before the index intervention, only 12% of patient s had severe angina at 6 months and 69% were completely free of angina. Non etheless, at 6 months, 39% of patients were receiving beta-adrenergic block ers (preprocedure proportion, 43%; P < 0.001), 36% were receiving nitrates (preprocedure proportion, 41%; P < 0.001), and 57% were receiving calcium-c hannel blockers (preprocedure proportion, 50%; P < 0.001). These trends per sisted for patients without hypertension and those who had complete revascu larization. Conclusions: Successful percutaneous coronary revascularization did not sub stantially supplant the use of antianginal medications, which were commonly used despite the marked improvement in anginal status. This may reflect re luctance to alter therapy once symptoms of angina subside. Guidelines on co ntinued medical therapy after percutaneous coronary revascularization are n eeded.