title: Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary intervention.
abstract: OBJECTIVE
  This study sought to compare use of evidence-based secondary preventive medications after coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Use of cardioprotective medication after coronary revascularization has been inconsistent and relatively low in older studies.
  
  
  METHODS
  We studied patients in a large integrated healthcare delivery system who underwent CABG or PCI for new onset coronary disease. We used data from health plan databases about prescriptions dispensed during the first year after initial coronary revascularization to identify patients who never filled a prescription and to calculate the medication possession ratio among patients who filled at least 1 prescription. We focused on angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), beta-blockers, and statins.
  
  
  RESULTS
  Between 2000 and 2007, 8,837 patients with new onset coronary disease underwent initial CABG, and 14,516 underwent initial PCI. Patients receiving CABG were more likely than patients receiving PCI to not fill a prescription for a statin (7.1% vs. 4.8%, p < 0.0001) or for an ACEI/ARB (29.1% vs. 22.4%, p < 0.0001), but similar proportions never filled a prescription for a beta-blocker (6.4% vs. 6.1%). Among those who filled at least 1 prescription post-revascularization, patients receiving CABG had lower medication possession ratios than patients receiving PCI for ACEI/ARBs (69.4% vs. 77.8%, p < 0.0001), beta-blockers (76.1% vs. 80.6%, p < 0.0001), and statins (82.7% vs. 84.2%, p < 0.001).
  
  
  CONCLUSIONS
  Patients who received CABG were generally less likely than patients who received PCI to fill prescriptions for secondary preventive medications and to use those medications consistently in the first year after the procedure.
authors.affiliation: Stanford University School of Medicine, Stanford, California 94305-5405, USA. hlatky@stanford.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Solomon
authors.forename: David
authors.initials: D
authors.lastname: Shilane
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Leong
authors.forename: Ralph
authors.initials: R
authors.lastname: Brindis
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D018890:Chemoprevention; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine