Abstract 3525: Targeting Risk Factors To Goals Is Associated With Better Outcomes Among Patients With Coronary Artery Bypass Surgery: Insights From the REACH Registry
Background: The relationship of achieving secondary prevention target treatment goals for cardiovascular risk factors with clinical outcomes in patients (pts) with prior coronary artery bypass surgery (CABG) in contemporary practice is less known.
Methods: The global REduction in Atherothrombosis for Continued Health (REACH) Registry includes 44 countries, over 68,000 pts, with data on baseline risk factors collected in 2003–2004. We evaluated the association between percent of individuals’ modifiable risk factors (diabetes, hypertension, hypercholesterolemia, smoking and body mass index [BMI]) at target treatment goal and 1-year outcomes in CABG pts. Risk factors were at goal if blood sugar was <126 mg/dl, blood pressure <140/90 mmHg, serum cholesterol <200 mg/dl, non-smoking status, and BMI <30 kg/m2 in pts with these risk factors. Percent risk factors at goal=number of risk factors at goal/total number of risk factors X 100.
Results: A total of 13,899 pts (20%) in REACH had prior CABG with 1-year outcomes data available in 13,207 pts. Risk factors at goal was achieved as follows: <25% at goal in 489, 25–<50% at goal in 1,701, 50–<75% at goal in 4,188 and >/=75% at goal in 6,828 pts and showed wide geographical variation. A strong inverse relationship was seen between percentage risk factors at goal and 1-year clinical events (Table⇓). Similarly, 1-year clinical events increased as the number of risk factors at goal decreased in these pts.
Conclusions: There is wide variation in post-CABG secondary prevention care. Although CABG pts are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure is associated with worse age and gender adjusted clinical outcomes. Thus, secondary prevention after CABG needs to focus on more comprehensive risk factor modifications to bring pts to target goals to prevent subsequent cardiovascular events and represents an opportunity to save many lives and function.