Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial

Abstract Coronary artery disease (CAD) is a major global health concern, and percutaneous coronary intervention (PCI) is commonly used for revascularization. Optimal medical therapy (OMT) is recommended to complement PCI. However, whether OMT significantly benefits high-risk CAD patients remains unclear. This study aimed to investigate potential benefits of OMT in high-risk CAD patients who underwent PCI, through a post-hoc subgroup analysis of the POST-PCI trial comparing patients who did and did not receive OMT. The primary endpoint was major cardiovascular events (death from any cause, myocardial infarction, or hospitalization for unstable angina) at 2 years; secondary endpoints included individual components of the primary outcome. The OMT group comprised patients with a higher prevalence of cardiovascular risk factors. However, clinical outcomes did not differ significantly between OMT and non-OMT groups. Additionally, the OMT group had a significantly reduced invasive coronary angiography rate than the non-OMT group (74.0% vs. 89.1%, odds ratio: 0.35, 95% confidence interval: 0.15–0.81, p = 0.014). The non-OMT group tended to have a higher proportion of symptomatic patients undergoing repeat revascularization than the OMT group (81.7% vs. 65.5%, p = 0.070). In conclusion, OMT did not result in significantly different clinical outcomes in high-risk CAD patients post-PCI compared with non-administration of OMT. However, OMT has potential benefits in reducing unnecessary procedures and optimizing patient care. Further studies are needed to better understand OMT benefits in this patient population.