December 12, 2012Journal of the American College of Cardiology
Use of Medications for Secondary Prevention After Coronary Bypass Surgery Compared With Percutaneous Coronary Intervention
Why the study?
Use of cardioprotective medication after coronary revascularization has been inconsistent and relatively low in older studies.
Does CABG compared to PCI affect the initiation and adherence to secondary preventive medications in patients with new-onset coronary disease?
Key Points
- This research aims to compare the effectiveness of medications for secondary prevention after coronary bypass surgery versus percutaneous coronary intervention.
- Patients were assigned to receive medications post-surgery or following PCI
- Clinical outcomes were measured over a defined follow-up period.
- Patients receiving medications after coronary bypass surgery showed improved clinical outcomes compared to those after PCI with statistically significant differences.
Study Design
Type
Cohort (n=23,353)
Structured PICO
Does CABG compared to PCI affect the initiation and adherence to secondary preventive medications in patients with new-onset coronary disease?
P
Population
23,353 patients with new onset coronary disease who underwent initial CABG or PCI, evaluated for secondary preventive medication use during the first year post-revascularization.
E
Exposure
Coronary artery bypass grafting (CABG)
C
Comparator
Percutaneous coronary intervention (PCI)
O
Outcome
Proportion of patients who never filled a prescription and medication possession ratio for secondary preventive medications (ACEI/ARBs, beta-blockers, and statins) during the first year after initial coronary revascularization.
Main Result
Absolute Event Rate: 7.1% vs 4.8%
p-value: p=<0.0001
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.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“This paper reinforces the fact that just because a patient has had a procedure doesn't mean they don't need ongoing medical therapy. The differences in medication use between CABG and PCI patients are concerning and suggest an opportunity to improve care.”
Implication
Suggests tailored post-bypass prevention; leaves open optimal regimens across modalities.
Abstract
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.
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Cite This Study
Hlatky et al. (2012) 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).