Hospital Variability Drives Inconsistency in Antiplatelet Use After Coronary Bypass
Jared P Beller1, William Z Chancellor1, J Hunter Mehaffey1
1Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
The Annals of Thoracic Surgery
|February 15, 2020
Summary
Dual antiplatelet therapy (DAPT) use after coronary artery bypass grafting (CABG) for myocardial infarction increased slightly but showed significant hospital variability. Guideline adherence requires hospital-level interventions to improve DAPT consistency.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Current guidelines recommend dual antiplatelet therapy (DAPT) continuation after coronary artery bypass grafting (CABG) in patients with recent myocardial infarction.
- Adherence to these guidelines is crucial for optimal patient outcomes.
Purpose of the Study:
- To evaluate temporal trends in DAPT use after CABG in myocardial infarction patients.
- To identify factors associated with DAPT prescription at discharge within a regional healthcare consortium.
Main Methods:
- Analysis of isolated CABG patients who experienced myocardial infarction within 21 days prior to surgery (2011-2017).
- Stratification by DAPT prescription at discharge and by time period (early: 2011-2014 vs. late: 2015-2017).
- Hierarchical regression models to assess factors influencing postoperative DAPT use.
Main Results:
- Overall DAPT utilization was 31.2%, increasing from 29.6% to 33.4% over the study period.
- Significant hospital-level variability in DAPT rates (9.5%-92.1%) was observed, with limited temporal changes at individual hospitals.
- Off-pump surgery and prior percutaneous coronary intervention were associated with increased DAPT, while atrial fibrillation was associated with decreased use.
Conclusions:
- DAPT use after CABG for myocardial infarction has increased, influenced by patient demographics.
- Inconsistent DAPT utilization across hospitals highlights a need for targeted interventions.
- Hospital-level strategies are essential to improve adherence to DAPT guidelines for these high-risk patients.
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