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Use of medications for secondary prevention after coronary bypass surgery compared with percutaneous coronary

Mark A Hlatky1, Matthew D Solomon, David Shilane

  • 1Stanford University School of Medicine, Stanford, California 94305-5405, USA. hlatky@stanford.edu

Journal of the American College of Cardiology
|December 19, 2012
PubMed

Insights

Patients undergoing coronary bypass surgery (CABG) were less likely to fill prescriptions for secondary preventive medications compared to those receiving percutaneous coronary intervention (PCI). This suggests lower medication adherence post-CABG.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • Cardioprotective medication use after coronary revascularization is historically inconsistent and suboptimal.
  • Evidence-based secondary preventive medications are crucial for long-term cardiovascular health post-procedure.

Purpose of the Study:

  • To compare the utilization of evidence-based secondary preventive medications between patients undergoing Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI).
  • To assess prescription fill rates and medication possession ratios for key cardiovascular drugs in the first year post-revascularization.

Main Methods:

  • Retrospective analysis of health plan data for patients with new-onset coronary disease undergoing CABG or PCI between 2000-2007.
  • Identification of patients who never filled prescriptions and calculation of medication possession ratios for ACE inhibitors (ACEI), ARBs, beta-blockers, and statins.
  • Focus on prescription data within the first year following initial coronary revascularization.

Main Results:

  • Patients receiving CABG were more likely to not fill prescriptions for statins (7.1% vs. 4.8%) and ACEI/ARBs (29.1% vs. 22.4%) compared to PCI patients.
  • Medication possession ratios were lower for CABG patients than PCI patients for ACEI/ARBs (69.4% vs. 77.8%), beta-blockers (76.1% vs. 80.6%), and statins (82.7% vs. 84.2%).
  • No significant difference was observed in the proportion of patients never filling a beta-blocker prescription (6.4% vs. 6.1%).

Conclusions:

  • Patients undergoing CABG demonstrated lower rates of filling and consistent use of secondary preventive medications in the first year post-procedure compared to those treated with PCI.
  • Findings highlight potential disparities in medication adherence based on revascularization strategy.
  • Further research is warranted to understand and address barriers to consistent medication use after CABG.
Abstract

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