Effect of best medical treatment before drug-eluting stent placement

This paper studied the outcome of optimal medical therapy before a drug-eluting stent placement.  Patients who achieved optimal medical therapy had better outcomes, but most patients did not achieve optimal medical therapy. 

A drug-eluting stent is a mesh structure that is placed into blood vessels and allows blood to flow smoothly, as well as releases drugs to prevent blood from clotting. This procedure is done for patients who have coronary artery disease, where the blood vessels to the heart become narrowed. It is not clear whether achieving optimal medical therapy (such as controlling blood pressure and blood glucose levels) prior to the implantation of stents affects outcomes. 

3004 patients who had a drug-eluting stent placement were studied. Before the stent placement, 18.2% of patients achieved optimal medical therapy. Optimal medical therapy meant that that they had low-density lipoprotein C  (type of cholesterol, or fat, in the blood) levels of less than 100 mg/dL, blood pressure of less than 130/80 mm Hg and blood glucose (sugar) levels of less than 7%.

Patients were followed for 24 months. The occurrence of target vessel failure (when patients either needed a repeat procedure, died or had a heart attack) was studied.

At 24 months, target vessel failure occurred in 7% of those who achieved optimal medical therapy and 10% in those who did not achieve optimal medical therapy. Patients who achieved optimal medical therapy were 32% less likely to have target vessel failure.  

A heart attack occurred in 0.5% of patients who achieved optimal medical therapy and 1.5% in patients who did not achieve optimal medical therapy. Patients who had blood glucose levels of less than 7% were 44% less likely to have target vessel failure. 

The authors concluded that patients achieving optimal medical therapy before stent placement were less likely to have target vessel failure. 

There was a small sample size of patients studied.