Guideline-directed medical therapy after revascularization and outcomes in ischaemic cardiomyopathy
Por:
Moliner-Abos, C, Calvo-Barcelo, M, Solé-Gonzalez, E, Martín, AB, Brugués, PF, Vega, JS, Jubany, JV, Vallverdú, MF, Ferrer, MT, Castillo, PET, Mancera, JCD, Rigau, PV, Olives, RV, Lopez, CD, Bayés-Genís, A, Aizpurua, DA, González, IF, Pérez, SM
Publicada:
1 dic 2025
Ahead of Print:
1 nov 2025
Resumen:
Aims Guideline-directed medical therapy (GDMT) remains the cornerstone for treating patients with heart failure (HF) and reduced ejection fraction (HFrEF) and coronary artery disease (CAD). However, real-world implementation of GDMT (GDMTi) is suboptimal. This subanalysis of the RevascHeart study evaluates the impact of GDMTi on long-term mortality in patients with de novo ischaemic heart failure (HF) undergoing revascularization.Methods Among 409 patients with HFrEF (left ventricular ejection fraction <= 40%) and CAD, 275 one-year survivors who underwent revascularisation shortly after index HF admission were included in this landmark analysis (LA). GDMTi at 12 months was defined as initiation of each recommended drug class, regardless of dose. Primary endpoints were all-cause and cardiovascular mortality by GDMTi. Secondary endpoints included outcomes by revascularisation strategy and temporal trends in GDMTi.Results Over a median follow-up of 41.6 months, all-cause mortality occurred in 29 GDMTi patients (18%) versus 47 non-GDMTi (42%) and cardiovascular mortality in 10% versus 24%, respectively. After adjustment, GDMTi was not significantly associated with lower all-cause [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.39-1.02; P = 0.06] or cardiovascular mortality (HR 0.62, 95% CI 0.33-1.18; P = 0.14). GDMTi/coronary artery bypass grafting (CABG) was associated with lower all-cause (HR 0.42, 95% CI 0.20-0.87; P = 0.02) and cardiovascular mortality (HR 0.40, 95% CI 0.16-0.99; P = 0.05). GDMTi use increased progressively over the study period.Conclusions GDMTi was associated with lower unadjusted mortality, though not significant after adjustment. GDMTi combined with CABG showed the best outcomes. The use of GDMTi improved over time.
Filiaciones:
Moliner-Abos, C:
Univ Autonoma Barcelona, Hosp Santa Creu i Santa Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Hosp Univ Dr Josep Trueta, Gastroenterol Dept, Girona, Spain
Inst Recerca Sant Pau IR SANTPAU, Barcelona, Spain
Inst Invest Biomed Girona IDIBGI, Girona, Spain
Calvo-Barcelo, M:
Hosp Univ Vall Hebron, Cardiol Dept, Barcelona, Spain
Solé-Gonzalez, E:
Hosp Clin Barcelona, Cardiol Dept, Barcelona, Spain
Martín, AB:
CIBERCV, Hosp Univ Germans Tries & Pujol, Cardiol Dept, Badalona, Spain
Brugués, PF:
Hosp Univ Dr Josep Trueta, Gastroenterol Dept, Girona, Spain
Inst Invest Biomed Girona IDIBGI, Girona, Spain
Vega, JS:
Hosp Univ Bellvitge, Cardiol Dept, Lhospitalet De Llobregat, Barcelona, Spain
Jubany, JV:
Univ Autonoma Barcelona, Hosp Santa Creu i Santa Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Vallverdú, MF:
Hosp Univ Sant Joan, Cardiol Dept, Reus, Spain
Ferrer, MT:
Univ Autonoma Barcelona, Hosp Santa Creu i Santa Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Inst Recerca Sant Pau IR SANTPAU, Barcelona, Spain
Castillo, PET:
Hosp Univ Vall Hebron, Cardiol Dept, Barcelona, Spain
Mancera, JCD:
Hosp Clin Barcelona, Cardiol Dept, Barcelona, Spain
Rigau, PV:
Hosp Univ Dr Josep Trueta, Gastroenterol Dept, Girona, Spain
Inst Invest Biomed Girona IDIBGI, Girona, Spain
Olives, RV:
Hosp Univ Vall Hebron, Cardiol Dept, Barcelona, Spain
Lopez, CD:
Hosp Univ Bellvitge, Cardiol Dept, Lhospitalet De Llobregat, Barcelona, Spain
Bayés-Genís, A:
CIBERCV, Hosp Univ Germans Tries & Pujol, Cardiol Dept, Badalona, Spain
Aizpurua, DA:
Univ Autonoma Barcelona, Hosp Santa Creu i Santa Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Inst Recerca Sant Pau IR SANTPAU, Barcelona, Spain
González, IF:
Hosp Univ Vall Hebron, Cardiol Dept, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
Pérez, SM:
Univ Autonoma Barcelona, Hosp Santa Creu i Santa Pau, Cardiol Dept, CIBERCV, Barcelona, Spain
Inst Recerca Sant Pau IR SANTPAU, Barcelona, Spain
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