Optimal medical therapy in patients with stable coronary artery disease in Poland. The ISCHEMIA Trial experience.

INTRODUCTION Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with ISCHEMIA Trial showing similar outcomes using OMT with or without an initial invasive approach. OBJECTIVES To describe OMT goal attainment among ISCHEMIA participants in Poland compared to other countries. PATIENTS AND METHODS Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. OMT targets were: not smoking, high-intensity statin therapy, LDL-C<70mg/dL, SBP<140mmHg, aspirin therapy, and ACE-I/ARB, beta-blocker therapy if indicated. RESULTS Compared to 36 other countries, at randomization participants in Poland were older (67 [62, 75] vs 65 [58, 71] yrs), P<0.001), more often female (30% vs 22%, P=0.002), with a longer angina history (3 [1, 9]yrs vs 1 [0, 3]yrs, P<0.001), more prior myocardial infarction (32% vs 18%, P <0.01) and revascularization (PCI: 40% vs 19%; CABG: 11% vs 3%, P<0.001). Number of OMT goals attained increased from baseline to follow-up (5 [4, 6] vs 6 [5, 6], P<0.001) in Poland and other countries alike (P=0.89, and P=0.14, resp). In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C<70mg/dl (29% vs 65%), and SBP<140mmHg (63% vs 81%), P<0.001; whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACE-I/ARB (93% vs 95%), and beta-blocker therapy (94% vs 90%) remained high. CONCLUSION With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among ISCHEMIA participants in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.