Patients undergoing CABG were more likely than those undergoing PCI to not fill a prescription for a statin (7.1% vs 4.8%, p<0.0001) or an ACEI/ARB (29.1% vs 22.4%, p<0.0001) in the first year.
Cohort (n=23,353)
Does CABG compared to PCI affect the initiation and adherence to secondary preventive medications in patients with new-onset coronary disease?
Patients undergoing CABG have significantly lower rates of initiation and adherence to evidence-based secondary prevention medications in the first year compared to those undergoing PCI.
Absolute Event Rate: 7.1% vs 4.8%
p-value: p=<0.0001
OBJECTIVES: 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.
“The findings suggest that there might be systematic factors after CABG and PCI that contribute to lower medication use after CABG. Addressing these differences might provide an opportunity to further improve the quality of care after coronary revascularization.”
Hlatky et al. (Wed,) conducted a cohort in New onset coronary disease (n=23,353). Coronary bypass surgery (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on Not filling a prescription for a statin (p=<0.0001). Patients undergoing CABG were more likely than those undergoing PCI to not fill a prescription for a statin (7.1% vs 4.8%, p<0.0001) or an ACEI/ARB (29.1% vs 22.4%, p<0.0001) in the first year.