title: Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery.
abstract: 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.
authors.affiliation: Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.forename: Gail E
authors.initials: GE
authors.lastname: Hafley
authors.forename: Stacy H
authors.initials: SH
authors.lastname: Graham
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Randall K
authors.initials: RK
authors.lastname: Wolf
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Daniel
authors.initials: D
authors.lastname: Gennevois
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors