Compliance with guideline-directed basic pharmacotherapy and late adverse events in patients with stable coronary artery disease after isolated surgical revascularization

Abstract

Abstract Background Long-term basic pharmacotherapy may have a major impact upon clinical course and survival in patients with stable coronary artery diseases (CAD) after isolated coronary artery bypass grafting (CABG). Purpose To determine the role of compliance with guideline-directed basic pharmacotherapy in the prevention of late major adverse clinical events (MAEs) in patients with stable CAD after isolated CABG at 3-year follow-up. Methods A single-centre study included 576 patients with stable CAD, consecutively enrolled for isolated CABG during the period 2011–2017. Follow-up median was 34 months (interquartile range 13–60 months). Two (0.3%) patients died early after CABG, thus 574 (99.7%) patients were followed post-discharge. At 3-year follow-up, data on MAEs were available in 251 patients, mean age (61±9) years, 218 (86.9%) males. Among them, MAEs occurred in 55 (21.9%) cases. Results Basic CAD pharmacotherapy after CABG was comparable in MAEs vs. no-MAEs groups, with the vast majority of patients receiving guideline-recommended therapy at discharge, namely angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptors blockers (ARBs) (79.6% vs. 88.8%, respectively; p=0.109), statins (98.1% vs. 99.0%, respectively; p=0.619) and antiplatelet drugs (98.1% vs. 99.5%, respectively; p=0.327). At 3-year follow-up, MAEs group, as opposed to no-MAEs group, was characterized by the lower usage of ACEI/ARBs (68.5% vs. 87.2%, respectively; p=0.001) and statins (59.3% vs. 86.7%, respectively; p<0.001), as well as triple basic CAD therapy (ACEI or ARBs/statins/antiplatelet drugs: 35.2% vs. 70.4%, respectively; p<0.001). Conclusion At 3-year follow-up, MAEs in patients with stable CAD after isolated CABG were associated with more frequent discontinuation of previously prescribed guideline-directed basic pharmacotherapy, namely ACEI/ARBs and statins, as well as triple basic CAD therapy. Funding Acknowledgement Type of funding source: None