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Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery.
Ann Thorac Surg. 2007 Mar; 83(3):993-1001.AT

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+Show Affiliations

Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17307447

Citation

Goyal, Abhinav, et al. "Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery." The Annals of Thoracic Surgery, vol. 83, no. 3, 2007, pp. 993-1001.
Goyal A, Alexander JH, Hafley GE, et al. Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery. Ann Thorac Surg. 2007;83(3):993-1001.
Goyal, A., Alexander, J. H., Hafley, G. E., Graham, S. H., Mehta, R. H., Mack, M. J., Wolf, R. K., Cohn, L. H., Kouchoukos, N. T., Harrington, R. A., Gennevois, D., Gibson, C. M., Califf, R. M., Ferguson, T. B., & Peterson, E. D. (2007). Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery. The Annals of Thoracic Surgery, 83(3), 993-1001.
Goyal A, et al. Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery. Ann Thorac Surg. 2007;83(3):993-1001. PubMed PMID: 17307447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes associated with the use of secondary prevention medications after coronary artery bypass graft surgery. AU - Goyal,Abhinav, AU - Alexander,John H, AU - Hafley,Gail E, AU - Graham,Stacy H, AU - Mehta,Rajendra H, AU - Mack,Michael J, AU - Wolf,Randall K, AU - Cohn,Lawrence H, AU - Kouchoukos,Nicholas T, AU - Harrington,Robert A, AU - Gennevois,Daniel, AU - Gibson,C Michael, AU - Califf,Robert M, AU - Ferguson,T Bruce,Jr AU - Peterson,Eric D, AU - ,, PY - 2006/07/27/received PY - 2006/10/10/revised PY - 2006/10/16/accepted PY - 2007/2/20/pubmed PY - 2007/3/31/medline PY - 2007/2/20/entrez SP - 993 EP - 1001 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 83 IS - 3 N2 - 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17307447/Outcomes_associated_with_the_use_of_secondary_prevention_medications_after_coronary_artery_bypass_graft_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)02075-3 DB - PRIME DP - Unbound Medicine ER -