Hospital Variability Drives Inconsistency in Antiplatelet use following Coronary Bypass

Abstract Background Continuation of dual antiplatelet therapy (DAPT) following coronary artery bypass grafting (CABG) after acute myocardial infarction is recommended by current guidelines. We sought to evaluate guideline adherence over time and factors associated with post-operative DAPT within a regional consortium. Methods Isolated CABG patients from 2011-2017 that had a myocardial infarction within 21 days prior to surgery were included. Patients were stratified by DAPT prescription at discharge and by time period, early (2011-2014) vs. late (2015-2017). Hierarchical regressions were then performed to evaluate factors influencing DAPT use after CABG. Results A total of 7,314 patients were included with an overall rate of DAPT utilization of 31.2% that increased from 29.6% in the early to 33.4% in the late era (p Conclusions Dual antiplatelet use has increased between 2011 and 2017, driven primarily by evolving patient demographics. Significant hospital level variability drives inconsistency in DAPT utilization. Efforts to promote DAPT use for patients treated with CABG after myocardial infarction in concordance with current guidelines should be targeted at the hospital level.