The Role of Basic Pharmacotherapy in the Prevention of Late Adverse Events After Elective Coronary Artery Bypass Grafting

Abstract

The aim: To determine the role of adherence to the guidelines on basic pharmacotherapy in prevention of late major adverse clinical events (MAEs) in patients with stable CAD for three years following isolated CABG. Materials and methods: A prospective single-centre study included 251 consecutive patients with stable CAD (mean age (61±9) years, 218 (86.9%) males), after isolated CABG. In three years MAЕs occurred in 55 (21.9%) patients. The data on pharmacotherapy at follow-up were obtained in 250 patients: 196 (78.4%) patients without MAEs (at scheduled visit) and 54 (21.6%) patients with MAEs (based on in-hospital or archive data). Results: Basic CAD pharmacotherapy after CABG was comparable in MAEs vs. no-MAEs groups, with the vast majority of patients receiving guideline-recommended therapy with angiotensin-converting enzyme inhibitors (ACEII) or angiotensin-II receptors blockers (ARBs), statins and antiplatelet drugs. At three years follow-up, MAEs group, as opposed to no-MAEs group, was characterized by the lower usage of ACEII/ARBs (68.5% vs. 87.2%, respectively; p=0,001) and statins (59.3% vs. 86.7%, respectively; p<0,001), as well as basic triple therapy (ACEII or ARBs/statins/antiplatelet drugs: 35.2% vs. 70.4%, respectively [p<0,001]). Conclusions: At three – year follow-up MAEs in patients with stable CAD after CABG were associated with more frequent discontinuation of previously prescribed basic pharmacotherapy, namely ACEII/ARBs and statins, as well as triple therapy (ACEII/ARBs, statins and antiplatelet drugs).

Early postoperative complications in patients with acute myocardial infarction during emergency coronary bypassing

“…A later meta-analysis, which is based on a study of individual patients from three studies comparing routine invasive and selective invasive approaches, showed lower mortality and MI during the 5-year followup (BP 0.81, 95.0 CI 0.71-0.93, p = 0.002), with the most significant difference in high-risk patients. Age, diabetes, history of MI, ST depression, hypertension, body mass index (<25 or> 35 kg / m 2), and treatment strategy were independent predictors of death and MI during follow-up (Dudek et al, 2018;Yepanchintseva et al, 2020).…”