Journal Article

Prognostic impact of guideline-directed medical therapy after functionally complete revascularisation in patients with obstructive coronary artery diseases

Zhang, Qi, Yu, Lilei, Fu, Guosheng, Qu, Xinkai, Zhao, Yanyan, Huang, Yunfei, Tu, Shengxian, Qiao, Shubin, Jiang, Yao, Guan, Changdong, Yu, Bo, Song, Lei, Yang, WeiXian, Geng, Yingyang, Pu, Jun

2026

Overview

ObjectiveFunctional complete revascularisation (FCR) has been proven to be associated with superior prognosis following percutaneous coronary intervention. Whether guideline-directed medical therapy (GDMT) still impacts clinical outcomes in patients who have achieved FCR requires further evaluation.MethodsThe study population was drawn from patients who achieved FCR in the FAVOR III China trial, defined as a quantitative flow ratio (QFR)-based residual functional Synergy between percutaneous coronary intervention with taxus and cardiac Surgery score of 0, measured only in vessels with QFR≤0.80. GDMT was defined as the combination of single or dual antiplatelet therapy, a beta-blocker and a statin, with or without an ACE inhibitor or angiotensin receptor blocker, according to contemporary guideline recommendations. Patients were categorised into the GDMT group (compliance with all 4 agents) or non-GDMT group (compliance with 0–3 agents). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 3 years, a composite of death, myocardial infarction, stroke and ischaemia-driven revascularisation.ResultsAmong 3221 (85.2%) patients who achieved FCR, a total of 1964 (61.2%), 1919 (59.9%), 1545 (48.4%), 1483 (46.6%) and 1084 (35.3%) patients adhered to GDMT at 1 month, 6 months, 1 year, 2 years and 3 years, respectively. The MACCE occurred in 313 (10.2%) patients through 3 years. The rate of MACCE was similar between GDMT and non-GDMT groups within the first year, but significantly lower in the GDMT group from the second year (adjusted HR: 0.66, 95% CI: 0.51 to 0.85; p<0.01) and sustained until the third year (adjusted HR: 0.65, 95% CI: 0.50 to 0.85; p<0.01), compared with the non-GDMT group.ConclusionsIn patients who achieved FCR, the benefit of good adherence to GDMT remained significant, starting from the second year and continuing up to 3 years.Trial registration number NCT03656848.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Acute coronary syndromes / Adrenergic beta-Antagonists - therapeutic use / Aged / Angioplasty / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Cardiology / Cardiovascular disease / China - epidemiology / Contraindications / Coronary Artery Disease / Coronary Artery Disease - diagnosis / Coronary Artery Disease - mortality / Coronary Artery Disease - physiopathology / Coronary Artery Disease - surgery / Coronary Artery Disease - therapy / Coronary vessels / Diabetes / Female / Flow velocity / Guideline Adherence / Heart attacks / Heart failure / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Ischemia / Male / Medical imaging / Middle Aged / Original Research / Patient compliance / Percutaneous Coronary Intervention / Percutaneous Coronary Intervention - adverse effects / Percutaneous Coronary Intervention - methods / Pharmacology, Clinical / Platelet Aggregation Inhibitors - therapeutic use / Practice Guidelines as Topic / Prognosis / Treatment Outcome / Vein & artery diseases