Under-use of secondary prevention medication in acute coronary syndrome patients treated with in-hospital coronary artery bypass graft surgery.

Background Acute coronary syndrome (ACS) patients treated with inpatient coronary artery bypass graft (CABG) surgery are at significant risk for future Major Adverse Cardiovascular events (MACE). The use of evidence-based medications (aspirin, statins, beta-blockers and angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBS)) can reduce MACE in these patients. Methods We used a prospective database of all patients admitted to the Green Lane Cardiovascular Service, Coronary Care Unit (CCU) at Auckland City Hospital (ACH). We contacted patients General Practitioners for current patient data including MACE, which was supplemented by using the hospital patient records. Results From 1/6/2006 to 31/7/2007, 901 patients presented with an ACS; of these 129 received inpatient CABG. 2 patients died before hospital discharge. At a median follow up time of 2.9 [IQR 2.7–3.3] years, 109 (86%) patients were traced and their medication assessed. Only 90 (83%) patients remained on aspirin, 78 (72%) on statins, 67 (62%) on beta-blockers and 47 (43%) on ACE inhibitors/ARBs. From the total of 127 patients discharged from hospital, there were a total of 18 MACE (6.2%/year): 3 unstable angina, 4 non-ST elevation myocardial infarction (NSTEMI), 6 congestive heart failure (CHF) and 5 deaths. Conclusion Suboptimal use of secondary prevention drugs in high risk ACS patients treated with urgent CABG surgery may contribute to subsequent adverse events. Greater efforts to optimise the use of these medications are needed to improve outcomes. Cardiovascular disease remains the commonest cause of death in New Zealand, being responsible for 10,480 (37%) of the 28,601 total deaths in 2007. 1 The prognostic benefit for the use of secondary prevention medication is well documented in coronary artery disease (CAD) patients including those who have undergone revascularisation with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. 2–4 Previous assessment of young patients <40 years of age from Green Lane Hospital, Auckland who received either PCI or CABG have demonstrated poor secondary prevention at follow up in 1994–1996. 5,6 We examined the modern day use of evidence-based medications (aspirin, statins, beta-blockers and angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)) in acute coronary syndrome (ACS) patients treated with inpatient CABG surgery. We assessed patients both at discharge and again at 3 years of follow-up in 2010.