Guideline-directed medical therapy after revascularization and outcomes in ischaemic cardiomyopathy
Moliner-Abós, Carles (Hospital Universitari de Girona Doctor Josep Trueta)
Calvo-Barceló, Maria (Hospital Universitari Vall d'Hebron)
Solé-Gonzalez, Eduard (Hospital Clínic i Provincial de Barcelona)
Borrellas Martín, Andrea (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Fluvià Brugués, Paula (Institut d'Investigació Biomèdica (Girona))
Sánchez Vega, Jesus (Hospital Universitari de Bellvitge)
Vime Jubany, Joan (Hospital Universitari Sant Joan de Reus (Tarragona))
Ferré Vallverdú, Maria (Hospital Universitari Sant Joan de Reus (Tarragona))
Taurón Ferrer, Manel (Institut de Recerca Sant Pau)
Tobias Castillo, Pablo Eduardo (Hospital Universitari Vall Hebrón)
de la Fuente Mancera, Juan Carlos (Hospital Clínic i Provincial de Barcelona)
Vilardell Rigau, Pau (Institut d'Investigació Biomèdica (Girona))
Vila Olives, Rosa (Hospital Universitari Vall Hebrón)
Diez López, Carles (Hospital Universitari de Bellvitge)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Arzamendi, Dabit (Institut de Recerca Sant Pau)
Ferreira-Gonzalez, Ignacio (Hospital Universitari Vall Hebrón)
Mirabet Pérez, Sonia (Institut de Recerca Sant Pau)

Date:	2025
Abstract:	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. 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. 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. 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.
Grants:	Ministerio de Economía y Competitividad CB16/11/00276
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Myocardial revascularization ; Heart failure ; Left ventricular dysfunction ; GDMT
Published in:	ESC Heart Failure, Vol. 12, Num. 6 (November 2025) , p. 4442-4450, ISSN 2055-5822

DOI: 10.1002/ehf2.70014
PMID: 41243815

9 p, 716.0 KB

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