Abstract 3725: Greater Use of Secondary Prevention Medications Following Coronary Artery Bypass Graft Surgery is Associated with Improved Two-Year Outcomes
Introduction: The use of antiplatelet agents, beta-blockers, lipid-lowering agents, and ACE inhibitors is beneficial following acute coronary syndromes and percutaneous coronary intervention. However, their impact on long-term clinical outcomes following coronary artery bypass graft surgery (CABG) has not been reported.
Hypothesis: We hypothesized that greater use of secondary prevention medications at hospital discharge following CABG is associated with lower rates of death or myocardial infarction (MI) over two years of follow-up.
Methods and Results. In the context of the PREVENT IV trial, 2970 patients undergoing first CABG were surveyed for the use of antiplatelet agents (aspirin or clopidogrel), beta-blockers, lipid-lowering agents, and ACE inhibitors or angiotensin receptor blockers at hospital discharge following CABG. Patients were categorized based on the percentage of indicated (class IA) medications that each patient was taking according to American College of Cardiology / American Heart Association guidelines (i.e. taking ≤50%, > 50% but < 100%, or 100% of indicated medications; Table⇓). Cox modeling was used to determine the association between treatment strata and two-year death or MI after adjustment for age, sex, recent MI, congestive heart failure, creatinine clearance, history of diabetes, the number of indicated medications, and the propensity to be taking 100% of indicated medications. There was a stepwise association between more complete use of secondary prevention medications and improved patient outcomes (p for trend = 0.0137; Table⇓).
Conclusions. Greater use of indicated secondary prevention medications following CABG is associated with lower a rate of death or MI at two years. These data underscore the importance of ensuring that patients are taking appropriate medical therapy following CABG to improve their long-term clinical outcomes.