title: Under-use of secondary prevention medication in acute coronary syndrome patients treated with in-hospital coronary artery bypass graft surgery.
abstract: BACKGROUND
  Acute coronary syndrome (ACS) patients treated with inpatient coronary artery bypass graft (CABG) surgery are at significant risk for future Major Adverse Cardiovascular events (MACE). The use of evidence-based medications (aspirin, statins, beta-blockers and angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBS)) can reduce MACE in these patients.
  
  
  METHODS
  We used a prospective database of all patients admitted to the Green Lane Cardiovascular Service, Coronary Care Unit (CCU) at Auckland City Hospital (ACH). We contacted patients General Practitioners for current patient data including MACE, which was supplemented by using the hospital patient records.
  
  
  RESULTS
  From 1/6/2006 to 31/7/2007, 901 patients presented with an ACS; of these 129 received inpatient CABG. 2 patients died before hospital discharge. At a median follow up time of 2.9 [IQR 2.7-3.3] years, 109 (86%) patients were traced and their medication assessed. Only 90 (83%) patients remained on aspirin, 78 (72%) on statins, 67 (62%) on beta-blockers and 47 (43%) on ACE inhibitors/ARBs. From the total of 127 patients discharged from hospital, there were a total of 18 MACE (6.2%/year): 3 unstable angina, 4 non-ST elevation myocardial infarction (NSTEMI), 6 congestive heart failure (CHF) and 5 deaths.
  
  
  CONCLUSIONS
  Suboptimal use of secondary prevention drugs in high risk ACS patients treated with urgent CABG surgery may contribute to subsequent adverse events. Greater efforts to optimise the use of these medications are needed to improve outcomes.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Grafton, Auckland 1023, New Zealand..
authors.forename: Khang L
authors.initials: KL
authors.lastname: Looi
authors.forename: Kok L
authors.initials: KL
authors.lastname: Chow
authors.forename: Jen L
authors.initials: JL
authors.lastname: Looi
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Sue
authors.initials: S
authors.lastname: Halliday
authors.forename: Harvey
authors.initials: H
authors.lastname: White
authors.forename: Chris
authors.initials: C
authors.lastname: Ellis
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002302:Cardiac Output; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin