Key result
Post-CABG major adverse events are linked to ~50% lower triple therapy adherence at three years.
Why the study?
To determine the role of adherence to guideline-based basic pharmacotherapy in preventing late major adverse clinical events in patients with stable CAD over three years following isolated CABG.
Does adherence to basic pharmacotherapy prevent late major adverse clinical events in patients with stable CAD after isolated CABG?
Observational (n=251)
No
Does adherence to basic pharmacotherapy prevent late major adverse clinical events in patients with stable CAD after isolated CABG?
Discontinuation of guideline-directed medical therapy (ACEI/ARBs, statins, antiplatelets) is associated with a significantly higher risk of major adverse clinical events three years after isolated CABG.
OBJECTIVE: 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. PATIENTS AND METHODS: 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: 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]). CONCLUSION: 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).
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Yepanchintseva et al. (2020) conducted an observational in Stable coronary artery disease after isolated coronary artery bypass grafting (n=251). Basic triple pharmacotherapy (ACEI/ARBs, statins, and antiplatelet drugs) vs. Non-adherence or discontinuation was evaluated on Usage of basic triple therapy at 3 years in patients with major adverse clinical events (MAEs) vs without MAEs (p=<0.001). Major adverse clinical events at three years after CABG were associated with significantly lower adherence to basic triple pharmacotherapy compared to patients without events (35.2% vs 70.4%).
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