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Patients who were revascularized for a non-ST-segment elevation myocardial infarction (NSTEMI) did better if they adhered to their medications, but those who couldn't stick to the recommended regimen were better off if they had surgery than a stent, a registry study found.

Individuals who adhered to their optimal medical therapy were more likely to enjoy over a period of roughly 7 years (HR 2.79, 95% 2.19-3.54), , of Columbia University Medical Center in New York City, and colleagues reported in the Oct. 25 issue of Circulation.

In fact, the advantage of sticking with prescribed medication was greater than that from getting coronary artery bypass grafting (CABG) instead of percutaneous coronary intervention (PCI; HR 1.68, 95% CI 1.38-2.04).

Among propensity-matched patients, CABG outcomes were superior to PCI outcomes in patients who didn't adhere to optimal medical therapy (P=0.001) -- but were not different in their peers who complied with optimal medical therapy (P=0.574).

"Regardless of coronary revascularization strategy, medication adherence has a dramatic effect on long-term outcome," Kurlansky's group concluded. "Among comparable patients who adhere to optimal medical therapy, outcomes of PCI and CABG may not differ; however, among nonadherent patients, CABG affords better major adverse cardiac event-free survival."

"Therefore, patient compliance with medical therapy may inform clinical decision making and should be incorporated into all future comparative studies of comparative coronary revascularization strategies."

Kurlansky's retrospective analysis of the CARE registry included NSTEMI patients who underwent CABG (n=973) or PCI (n=2,255) at eight community hospitals over a 6-month period in 2004. Follow-up lasted a median of 84 months for the CABG arm and 79.4 months for PCI.

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