Related Experiment Video
Updated: Feb 14, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Guideline-directed medical therapy for secondary prevention after coronary artery bypass grafting in patients with
Malin Stenman1,2, Martin J Holzmann3,4, Ulrik Sartipy1,2
1Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Sweden.
Insights
Preoperative depression did not impact medication use after coronary artery bypass grafting (CABG). This suggests depression doesn't explain higher mortality rates in these patients.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Guideline-directed medical therapy (GDMT) is crucial for secondary prevention after coronary artery bypass grafting (CABG).
- Depression is a common comorbidity in cardiovascular disease patients.
- Previous studies suggest depression may negatively impact cardiovascular outcomes.
Purpose of the Study:
- To investigate the association between preoperative depression and the use of GDMT for secondary prevention in patients undergoing CABG.
- To determine if depression influences adherence to antiplatelet agents, beta-blockers, ACE inhibitors/ARBs, and statins post-CABG.
Main Methods:
- A Swedish cohort study included patients undergoing primary isolated CABG between 2006 and 2008.
- Individual-level data from national registers were linked to identify patients with preoperative depression (defined by antidepressant prescriptions).
- Medication use (at least two prescriptions) for four key classes was assessed at one and four years post-CABG.
Main Results:
- High rates of GDMT use were observed one year post-CABG (e.g., 93% for antiplatelet agents, 57% for all four classes).
- Medication adherence decreased by four years, with 44% using all four classes.
- Preoperative depression was not significantly associated with lower use of any medication class or all four classes at either time point.
Conclusions:
- Preoperative depression was not linked to reduced use of secondary prevention medications after CABG.
- The higher mortality observed in depressed patients post-CABG is unlikely due to inadequate medical therapy adherence.
- Further research is needed to understand the mechanisms behind increased mortality in depressed CABG patients.
Background:
We hypothesized that depressed patients would have lower use of guideline-directed medical therapy for secondary prevention of cardiovascular events following coronary artery bypass grafting (CABG).
Methods:
We included all patients who underwent primary isolated CABG in Sweden between 2006 and 2008. We cross-linked individual level data from national Swedish registers. Preoperative depression was defined as at least one antidepressant prescription dispensed before surgery. We defined medication use as at least two dispensed prescriptions in each medication class (antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB), and statins) within a rolling 12 month period. We calculated adjusted risk ratios (RR) for the use of each medication class, and for all four classes, after one and four years, respectively.
Results:
During the first year after CABG, 93% of all patients (n = 10,586) had at least two dispensed prescriptions for an antiplatelet agent, 68% for an ACEI/ARB, 91% for a beta-blocker, and 92% for a statin. 57% had prescriptions for all four medication classes. After four years (n = 4034), 44% had filled prescriptions for all four medication classes. Preoperative depression was not significantly associated with a lower use of all four medication classes after one year (RR 0.98, 95% confidence interval (CI) 0.93-1.03) or after four years (RR 0.97, 95% CI 0.86-1.09).
Conclusions:
Preoperative depression was not associated with lower use of guideline-directed medical therapy for secondary prevention after CABG. These findings suggest that the observed higher mortality following CABG among depressed patients is not explained by inadequate secondary prevention medication.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention