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Comparison of Preventive Cardiovascular Pharmacotherapy in Surgical vs Percutaneous Coronary Revascularization
Arden R Barry1,2, Erica H Z Wang1,3, Doson Chua3
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Patients undergoing coronary artery bypass grafting (CABG) show lower use of key cardiovascular medications like P2Y12 inhibitors and angiotensin-modulating agents post-acute coronary syndrome (ACS) compared to those receiving percutaneous coronary intervention (PCI). This highlights a gap in secondary preventive pharmacotherapy for CABG patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacotherapy
Background:
- Patients undergoing coronary artery bypass grafting (CABG) historically exhibit lower utilization of secondary preventive cardiovascular pharmacotherapy compared to those treated with percutaneous coronary intervention (PCI).
- This disparity necessitates an evaluation of pharmacotherapy prescribing patterns following acute coronary syndrome (ACS) based on revascularization strategy.
Purpose of the Study:
- To compare the rates of secondary preventive pharmacotherapy use at discharge among patients who underwent CABG versus PCI after experiencing an ACS.
- To identify potential underutilization of critical cardiovascular medications in specific revascularization patient groups.
Main Methods:
- A prospective cohort study was conducted involving adult patients diagnosed with ACS between January and November 2018.
- Data collection focused on pharmacotherapy use at discharge and documented reasons for non-use (e.g., intolerance, contraindications) for patients undergoing either CABG or PCI.
Main Results:
- While acetylsalicylic acid, beta-blockers, and statins were widely used across both groups, significant differences emerged for other agents.
- Patients undergoing PCI showed higher use of P2Y12 inhibitors (99% vs. 26%) and angiotensin-modulating agents (98% vs. 65%) compared to CABG patients.
- Maximum-dose statin therapy was more prevalent in the PCI group (89% vs. 64%).
Conclusions:
- Secondary preventive pharmacotherapy, including P2Y12 inhibitors and angiotensin-modulating agents, was underused in patients treated with CABG post-ACS, even when accounting for justified non-use.
- Despite high use of aspirin, beta-blockers, and statins, the findings indicate a need to optimize pharmacotherapy strategies for CABG patients to align with evidence-based secondary prevention guidelines.
Background:
Data suggest that patients who undergo coronary artery bypass grafting (CABG) have a lower rate of secondary preventive cardiovascular pharmacotherapy use compared with patients who undergo percutaneous coronary intervention (PCI). This study sought to assess the rate of use of preventive pharmacotherapy at discharge in patients who underwent CABG vs PCI post-acute coronary syndrome (ACS).
Methods:
A prospective cohort study was conducted at St Paul's Hospital in Vancouver, Canada. Patients aged ≥ 18 years who presented with an ACS and underwent CABG or PCI between January and November 2018 were included. Data on preventive pharmacotherapy use and reasons for justified nonuse (eg, intolerance, contraindication) were collected.
Results:
A total of 275 patients were included. Mean age was 65 years, and 83% were male. Overall, 141 patients (51%) underwent CABG and 134 patients (49%) underwent PCI. All patients received acetylsalicylic acid, but more patients who underwent CABG received 325 mg (vs 80-81 mg) compared to PCI (25% vs 1%, P < 0.01). Use of P2Y12 inhibitors was higher in patients who underwent PCI (primarily ticagrelor) compared with patients who underwent CABG (primarily clopidogrel) (99% vs 26%, P < 0.01). All patients who underwent CABG received a β-blocker vs 96% of patients who underwent PCI (P = 0.017). Use of angiotensin-modulating agents was higher in patients who underwent PCI (98% vs 65%, P < 0.01). Statin use was similar between groups (99% vs 99%, P = 0.96), but more patients who underwent PCI received maximum-dose therapy (89% vs 64%, P < 0.01).
Conclusions:
Use of acetylsalicylic acid, β-blockers, and statins in patients post-ACS was high regardless of revascularization strategy, whereas P2Y12 inhibitors and angiotensin-modulating agents were underused in patients who underwent CABG even after adjusting for justified nonuse.
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