ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
John H. Alexander
Rajendra H. Mehta
Michael J. Mack
Randall K. Wolf
Lawrence H. Cohn
Nicholas T. Kouchoukos
T. Bruce Ferguson, Jr
Eric D. Peterson
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goyal, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Goyal, A.
Related Collections
Right arrow Coronary disease

Ann Thorac Surg 2007;83:993-1001
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery

Abhinav Goyal, MD, MHSa, John H. Alexander, MD, MHSa,*, Gail E. Hafley, MSa, Stacy H. Graham, MDa, Rajendra H. Mehta, MD, MSa, Michael J. Mack, MDb, Randall K. Wolf, MDc, Lawrence H. Cohn, MDd, Nicholas T. Kouchoukos, MDe, Robert A. Harrington, MDa, Daniel Gennevois, MDf, C. Michael Gibson, MDg, Robert M. Califf, MDa, T. Bruce Ferguson, Jr, MDh, Eric D. Peterson, MD, MPHa PREVENT IV Investigators

a Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
b Cardiothoracic Surgery Associates of North Texas, Dallas, Texas
c University of Cincinnati Surgeons, Inc, Cincinnati, Ohio
d Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
e Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, Missouri
f Corgentech, Inc, San Francisco, California
g Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
h Division of Cardiothoracic Surgery, Brody School of Medicine at Eastern Carolina University, Greenville, North Carolina

Accepted for publication October 16, 2006.

* Address correspondence to Dr Alexander, Duke University Medical Center, DUMC Box 3850, Durham, NC 27710 (Email: john.h.alexander{at}duke.edu).

Background: Secondary prevention medications are beneficial after acute coronary syndromes, but these benefits are less clear after coronary artery bypass graft surgery. We investigated whether greater use of secondary prevention medications after coronary artery bypass graft surgery is associated with improved clinical outcomes.

Methods: Patients undergoing coronary artery bypass graft surgery in the PREVENT IV trial (n = 2970) were surveyed for use of antiplatelet agents, ß-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and lipid-lowering agents after hospital discharge and at 1 year. Patients were categorized based on their percentage use of indicated medications after hospital discharge. Cox modeling was used to determine the association between medication use categories and rates of death or myocardial infarction through 2 years after adjustment for clinical factors, the number of indicated medications, and treatment propensity.

Results: Rates of use of antiplatelet agents and lipid-lowering agents were high at discharge and at 1 year, but use of ß-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was suboptimal. There was a stepwise association between medication use at discharge and patient outcomes (p for trend = 0.014). Patients taking 50% or less of indicated medications at discharge had a significantly higher 2-year rate of death or myocardial infarction (8.0% versus 4.2%; adjusted hazard ratio, 1.69; 95% confidence interval, 1.12 to 2.55; p = 0.013) than those taking all indicated medications.

Conclusions: Greater use of indicated secondary prevention medications after coronary artery bypass graft surgery is associated with a lower 2-year rate of death or myocardial infarction. These data underscore the importance of appropriate secondary prevention measures to improve long-term clinical outcomes after coronary artery bypass graft surgery.




This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol., April 29, 2008; 51(17): 1707 - 1718.
[Full Text] [PDF]

Home page
 HeartHome page
T. Gershlick and M. Thomas
PCI or CABG: which patients and at what cost?
Heart, October 1, 2007; 93(10): 1188 - 1190.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The Society of Thoracic Surgeons.