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Published on: March 27, 2018
Impact of statins and beta-blocker therapy on mortality after coronary artery bypass graft surgery
Femi Philip1, Eugene Blackstone1, Samir R Kapadia1
11 Department of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California, USA ; 2 Department of Cardiovascular Medicine and Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA.
Insights
Discharge statin therapy after coronary artery bypass graft surgery (CABG) significantly reduces long-term mortality and major adverse cardiovascular events (MACE). Beta-blockers and statins together show synergistic effects on survival outcomes.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Retrospective cohort study assessing post-coronary artery bypass graft surgery (CABG) discharge regimens.
- Focus on the impact of beta-blockers and statin therapy on long-term outcomes.
Purpose of the Study:
- To evaluate the relationship between discharge medications and long-term all-cause mortality.
- To assess the effect on major adverse cardiovascular events (MACE) after isolated CABG.
Main Methods:
- Identified 5,205 adult patients undergoing first-time isolated CABG between 1993-2005.
- Utilized the Cardiovascular Information Registry (CVIR) for patient data and follow-up.
- Collected follow-up data at 30 days, 90 days, and annually.
Main Results:
- Statin therapy at discharge was associated with reduced 30-day, 1-year, and long-term mortality.
- The composite endpoint of death, myocardial infarction, and stroke was significantly lower in patients on statins.
- Statin and beta-blocker therapy demonstrated synergistic effects on mortality.
Conclusions:
- Post-discharge statin therapy independently lowers overall and 1-year mortality following CABG.
- Findings support current clinical guidelines for cardiovascular disease management.
- Results are consistent with previous studies in a contemporary surgical population.
Background:
We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods:
We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results:
We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions:
A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
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