Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery.
BACKGROUND
Secondary prevention medications are beneficial after acute coronary syndromes, but these benefits are less clear after coronary artery bypass graft surgery. We investigated whether greater use of secondary prevention medications after coronary artery bypass graft surgery is associated with improved clinical outcomes.


METHODS
Patients undergoing coronary artery bypass graft surgery in the PREVENT IV trial (n = 2970) were surveyed for use of antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents after hospital discharge and at 1 year. Patients were categorized based on their percentage use of indicated medications after hospital discharge. Cox modeling was used to determine the association between medication use categories and rates of death or myocardial infarction through 2 years after adjustment for clinical factors, the number of indicated medications, and treatment propensity.


RESULTS
Rates of use of antiplatelet agents and lipid-lowering agents were high at discharge and at 1 year, but use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was suboptimal. There was a stepwise association between medication use at discharge and patient outcomes (p for trend = 0.014). Patients taking 50% or less of indicated medications at discharge had a significantly higher 2-year rate of death or myocardial infarction (8.0% versus 4.2%; adjusted hazard ratio, 1.69; 95% confidence interval, 1.12 to 2.55; p = 0.013) than those taking all indicated medications.


CONCLUSIONS
Greater use of indicated secondary prevention medications after coronary artery bypass graft surgery is associated with a lower 2-year rate of death or myocardial infarction. These data underscore the importance of appropriate secondary prevention measures to improve long-term clinical outcomes after coronary artery bypass graft surgery.
Goyal
Abhinav
A
Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Alexander
John H
JH
Hafley
Gail E
GE
Graham
Stacy H
SH
Mehta
Rajendra H
RH
Mack
Michael J
MJ
Wolf
Randall K
RK
Cohn
Lawrence H
LH
Kouchoukos
Nicholas T
NT
Harrington
Robert A
RA
Gennevois
Daniel
D
Gibson
C Michael
CM
Califf
Robert M
RM
Ferguson
T Bruce
TB
Peterson
Eric D
ED
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011182:Postoperative Care; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors