Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery

Goyal, Abhinav; Alexander, John H.; Hafley, Gail E.; Graham, S.; Mehta, Rajendra H.; Wolf, Randall K.; Cohn, Lawrence H.; Kouchoukos, Nicholas T.; Harrington, Robert A.; Gennevois, Daniel; Gibson, C. Michael; Califf, Robert M.; Ferguson, T. Bruce; Peterson, Eric D.

doi:10.1016/j.athoracsur.2006.10.046

Cited by 82 publications

(95 citation statements)

References 36 publications

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“…This recommendation is also supported by a post hoc analysis of patients undergoing CABG in the PREVENT IV trial (n=2970), in which individual components of OMT (except antiplatelet therapy) did not show a significant benefit but the combination (OMT) reduced mortality and MI at the 2-year followup. 28 Furthermore, our suggestion of not limiting these drugs to patients with CAD and other comorbidities is strengthened by data from the Alberta Provincial Program for Outcome Assessment in Coronary Heart Disease (APPROACH) study, in which patients discharged with β-blockers after cardiac surgery exhibited a substantially lower mortality at the 1-year follow-up, even those without a history of MI or heart failure. 40 However, it is prudent to highlight that SYNTAX patients had complex CAD and a significant proportion had other comorbidities, including hypertension, diabetes mellitus, and previous MI.…”

Section: Discussionmentioning

confidence: 99%

“…29 Although antiplatelet agents and lipid-lowering agents were used in more than two thirds of the SYNTAX patients, use of angiotensin-converting enzyme inhibitor and β-blockers was consistently below 50%, which is similar to the report from CABG patients in the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial. 28 The ) were still underway during the conduct of SYNTAX trial. It is therefore plausible that OMT was yet to gain full traction in the clinical arena.…”

Section: Discussionmentioning

confidence: 99%

“…OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, consistent with published literature. [28][29][30] The study end point was the impact of OMT on mortality at 5 years. We also investigated a composite end point (death/myocardial infarction [MI]/stroke) at the 5-year follow-up.…”

Section: Study Medication End Points and Definitionsmentioning

confidence: 99%

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Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

et al. 2015

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Background-There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results-The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions-The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Medication End Points and Definitionsmentioning

confidence: 99%

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Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

et al. 2015

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“…[113,114] The PREVENT IV trial, including almost 3,000 patients that underwent CABG, demonstrated that rates of use of secondary prevention medications in patients with ideal indications for these therapies are high for antiplatelet agents and lipid-lowering therapy, but suboptimal for beta-blockers and ACE inhibitors or ARBs. [115] The study demonstrated that the use of multiple secondary prevention medications after CABG was associated with significant improve in clinical outcome death or MI at 2 years (4.2% in patients taking all indicated medications versus 9.0% in patients taking half or fewer of the indicated medications). No association was found between the use of most individual medications and subsequent outcomes, thus underscoring the importance of ensuring appropriate secondary prevention measures after CABG.…”

Section: Medical Therapymentioning

confidence: 99%

Treatment of Coronary Artery Bypass Graft Failure

Beijk¹,

Harskamp²

2013

Artery Bypass

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“…There is 1 cohort study of coronary artery bypass graft surgery patients that assessed aspirin, ACE inhibitor, beta-blocker, and statin use and found associations with decreased mortality. 19 As preoperative coronary revascularization has not been found to produce improved survival after vascular surgery, clarifying which perioperative medicines alone or in combination may improve outcomes becomes even more important. 20 We sought to ascertain if the use of concurrent combination aspirin, ACE inhibitors, beta-blockers, and statins compared to nonuse was associated with a decrease in 6-month mortality after vascular surgery.…”

mentioning

confidence: 99%