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Optimal medical therapy in patients with reduced left ejection fraction undergoing coronary artery bypass graft

Anna Jonsson Holmdahl1, Saman Sharif2, Erik Birring2

  • 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90185, Sweden. anna.l.jonsson@umu.se.

BMC Cardiovascular Disorders
|November 28, 2025
PubMed

Insights

Optimal medical therapy (OMT) significantly improves outcomes for patients with reduced ejection fraction undergoing coronary artery bypass graft surgery (CABG). Prescribing OMT at discharge lowers heart failure hospitalizations and all-cause mortality, demonstrating its crucial role in post-CABG care.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pharmacology

Background:

  • Reduced left ventricular ejection fraction (LVEF) is a critical factor in patients undergoing coronary artery bypass graft surgery (CABG).
  • The impact of optimal medical therapy (OMT) on clinical outcomes in this high-risk population remains an area of active investigation.

Purpose of the Study:

  • To evaluate the association between optimal medical therapy (OMT) and clinical outcomes in patients with reduced left ventricular ejection fraction (LVEF) undergoing coronary artery bypass graft surgery (CABG).

Main Methods:

  • A single-centre observational study included patients with preoperative LVEF ≤ 40% who underwent isolated CABG between 2012 and 2021.
  • OMT was defined as the concurrent prescription of renin-angiotensin-aldosterone system inhibitors (RAAS-I), beta-blockers (BB), acetylsalicylic acid (ASA), and statins.
  • Data were collected from medical records and a dedicated register.

Main Results:

  • Out of 102 identified patients, OMT prescription increased from 44% at admission to 67% at discharge, with sustained rates at follow-up.
  • Patients receiving OMT at discharge showed a significantly longer median time to composite endpoint of hospitalization and all-cause mortality (7.1 vs 1.7 years).
  • OMT at discharge was linked to a substantially lower adjusted risk of all-cause mortality and heart failure hospitalization (aHR, 0.25).

Conclusions:

  • OMT prescription rates increased post-CABG, stabilizing by 2 months follow-up.
  • Patients with reduced LVEF undergoing CABG who received OMT at discharge experienced improved clinical outcomes.
  • OMT at discharge is associated with a reduced risk of heart failure hospitalization and all-cause mortality in this patient cohort.
Abstract

Keywords:
Coronary artery bypass graftingHeart failureOptimal medical therapySecondary prevention

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