Why the study?
Long-term use of secondary prevention medications after CABG and their associations with mortality needed evaluation.
Does the use of secondary prevention medications (statins, β-blockers, RAAS inhibitors, platelet inhibitors) reduce long-term mortality in patients after isolated CABG?
Does the use of secondary prevention medications (statins, β-blockers, RAAS inhibitors, platelet inhibitors) reduce long-term mortality in patients after isolated CABG?
Statins, RAAS inhibitors, and platelet inhibitors are associated with improved long-term survival after CABG, while the routine use of β-blockers may not provide a mortality benefit.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The study shows that continuous treatment with statins, RAAS inhibitors, and platelet inhibitors is essential for long-term survival after coronary artery bypass grafting (CABG). The observed decrease in use of these medications over time after CABG is therefore alarming and poses an area for improvement.”
“CABG is not a cure for coronary artery disease, but it's symptom-relieving. Coronary artery disease is chronic and progressive in both the native vessels and grafts. Therefore, you need to continue treating it.”
“With bypass surgery, medications definitely get overlooked a lot of the time. Saying to someone, 'Okay, you have to take the aspirin forever, you have to take a statin forever,' it is harder for patients to accept that they need a medication to control their disease.”
Statin, RAAS-inhibitor, and platelet-inhibitor use was associated with lower long-term mortality; extends observational data but leaves causal effects open to randomized confirmation.
AIMS: To evaluate the long-term use of secondary prevention medications [statins, β-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, and platelet inhibitors] after coronary artery bypass grafting (CABG) and the association between medication use and mortality. METHODS AND RESULTS: All patients who underwent isolated CABG in Sweden from 2006 to 2015 and survived at least 6 months after discharge were included (n = 28 812). Individual patient data from SWEDEHEART and other mandatory nationwide registries were merged. Multivariable Cox regression models using time-updated data on dispensed prescriptions were used to assess associations between medication use and long-term mortality. Statins were dispensed to 93.9% of the patients 6 months after discharge and to 77.3% 8 years later. Corresponding figures for β-blockers were 91.0% and 76.4%, for RAAS inhibitors 72.9% and 65.9%, and for platelet inhibitors 93.0% and 79.8%. All medications were dispensed less often to patients ≥75 years. Treatment with statins [hazard ratio (HR) 0.56, 95% confidence interval (95% CI) 0.52-0.60], RAAS inhibitors (HR 0.78, 95% CI 0.73-0.84), and platelet inhibitors (HR 0.74, 95% CI 0.69-0.81) were individually associated with lower mortality risk after adjustment for age, gender, comorbidities, and use of other secondary preventive drugs (all P < 0.001). There was no association between β-blockers and mortality risk (HR 0.97, 95% CI 0.90-1.06; P = 0.54). CONCLUSION: The use of secondary prevention medications after CABG was high early after surgery but decreased significantly over time. The results of this observational study, with inherent risk of selection bias, suggest that treatment with statins, RAAS inhibitors, and platelet inhibitors is essential after CABG whereas the routine use of β-blockers may be questioned.
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Björklund et al. (2019) studied this question.
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