Efficacy of Telemedical Interventional Management in Patients with Coronary Heart Disease Undergoing Percutaneous Coronary Intervention: Randomized Controlled Trial.

Background: Coronary heart disease (CHD) continues to be a leading cause of global morbidity and mortality, with patients undergoing percutaneous coronary intervention (PCI) facing a significant risk of recurrent cardiovascular events. While secondary prevention strategies, such as medication adherence and lifestyle modifications, are essential, implementation gaps remain due to limited health care access and inadequate patient engagement. Telemedical interventions offer a promising solution to these challenges by facilitating remote monitoring and providing individualized patient management strategies. Objective: This randomized controlled trial aimed to evaluate the efficacy of a comprehensive web-based telemedical interventional management system in reducing major adverse cardiac and cerebrovascular events (MACCE) and enhancing secondary prevention outcomes among patients with CHD following PCI, compared to usual care alone. Methods: We conducted a single-center, open-label, randomized controlled trial at a tertiary hospital in China. A total of 2086 patients with post-PCI CHD were randomly assigned in a 1:1 ratio to receive either telemedical management combined with usual care (intervention group; n=1040) or usual care alone (control group; n=1046). The control group received follow-up phone calls from health care providers at 1, 3, 6, and 12 months after discharge. In contrast, the remote patient management group benefited from multicomponent interventions delivered through a telemedicine platform, alongside usual care. This platform provided personalized health education, medication reminders, vital sign monitoring, and artificial intelligence-assisted consultations. The primary outcome was the composite incidence of MACCE, including cardiac death, myocardial infarction, stroke, or target vessel revascularization, at one year. Secondary outcomes included bleeding events, lifestyle changes, blood pressure control, and medication adherence. Results: At the one-year follow-up, the intervention group demonstrated a significant reduction in MACCE compared to the control group (36/1040, 3.5% vs 55/1046, 5.3%, P=.04). This was primarily attributed to lower rates of cardiac death (10/1040, 1.0% vs 24/1046, 2.3%, P=.02) and myocardial infarction (8/1040, 0.8% vs 19/1046, 1.8%, P=.03). Additionally, bleeding events classified as BARC 3-5 were less frequent in the intervention group (6/1040, 0.6% vs 16/1046, 1.6%, P=.03). The intervention group also exhibited improved control over systolic blood pressure (mean 117.74, SD 13.80 mmHg vs mean 121.46, SD 16.85 mmHg, P=.002) and diastolic blood pressure (mean 73.60, SD 10.18 mmHg vs mean 75.72, SD 10.45 mmHg, P=.02), along with higher medication adherence to aspirin (896/1021, 87.8% vs 858/1017, 84.4%, P=.03) and angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors (489/1021, 47.9% vs 442/1017, 43.5%, P=.045). Furthermore, there was a notable reduction in alcohol consumption among participants in the intervention group (119/1021, 11.7% vs 168/1017, 16.5%, P=.002), alongside a trend towards decreased smoking rates (114/1021, 11.2% vs 142/1017, 14.0%, P=.06). Conclusions: Telemedical interventional management significantly enhanced clinical outcomes by reducing MACCE and improving risk factor control among patients with CHD who underwent PCI. These findings underscore the potential of telemedicine to bolster secondary prevention efforts and long-term care strategies. Further multicenter studies are necessary to validate these results and optimize telemedicine frameworks for broader implementation.