CABG was associated with significantly lower use of P2Y12 inhibitors (26% vs 99%, P<0.01) and angiotensin-modulating agents (65% vs 98%, P<0.01) at discharge compared to PCI in post-ACS patients.
Cohort (n=275)
No
Does the rate of preventive cardiovascular pharmacotherapy use at discharge differ between patients undergoing CABG versus PCI for acute coronary syndrome?
Patients undergoing CABG for acute coronary syndrome are significantly less likely to be prescribed guideline-directed secondary prevention therapies like P2Y12 inhibitors and angiotensin-modulating agents at discharge compared to those undergoing PCI.
Absolute Event Rate: 26% vs 99%
p-value: p=<0.01
BackgroundData suggest that patients who undergo coronary artery bypass grafting (CABG) have a lower rate of secondary preventive cardiovascular pharmacotherapy use compared with patients who undergo percutaneous coronary intervention (PCI). This study sought to assess the rate of use of preventive pharmacotherapy at discharge in patients who underwent CABG vs PCI post–acute coronary syndrome (ACS).MethodsA prospective cohort study was conducted at St Paul’s Hospital in Vancouver, Canada. Patients aged ≥ 18 years who presented with an ACS and underwent CABG or PCI between January and November 2018 were included. Data on preventive pharmacotherapy use and reasons for justified nonuse (eg, intolerance, contraindication) were collected.ResultsA total of 275 patients were included. Mean age was 65 years, and 83% were male. Overall, 141 patients (51%) underwent CABG and 134 patients (49%) underwent PCI. All patients received acetylsalicylic acid, but more patients who underwent CABG received 325 mg (vs 80-81 mg) compared to PCI (25% vs 1%, P < 0.01). Use of P2Y12 inhibitors was higher in patients who underwent PCI (primarily ticagrelor) compared with patients who underwent CABG (primarily clopidogrel) (99% vs 26%, P < 0.01). All patients who underwent CABG received a β-blocker vs 96% of patients who underwent PCI (P = 0.017). Use of angiotensin-modulating agents was higher in patients who underwent PCI (98% vs 65%, P < 0.01). Statin use was similar between groups (99% vs 99%, P = 0.96), but more patients who underwent PCI received maximum-dose therapy (89% vs 64%, P < 0.01).ConclusionsUse of acetylsalicylic acid, β-blockers, and statins in patients post-ACS was high regardless of revascularization strategy, whereas P2Y12 inhibitors and angiotensin-modulating agents were underused in patients who underwent CABG even after adjusting for justified nonuse.
Barry et al. (Sat,) conducted a cohort in Acute coronary syndrome (n=275). Coronary artery bypass grafting (CABG) vs. Percutaneous coronary intervention (PCI) was evaluated on Use of P2Y12 inhibitors at discharge (p=<0.01). CABG was associated with significantly lower use of P2Y12 inhibitors (26% vs 99%, P<0.01) and angiotensin-modulating agents (65% vs 98%, P<0.01) at discharge compared to PCI in post-ACS patients.