Date Published: May 2, 2019
Publisher: Public Library of Science
Author(s): Wen-Han Feng, Chun-Yuan Chu, Po-Chao Hsu, Wen-Hsien Lee, Ho-Ming Su, Tsung-Hsien Lin, Hsueh-Wei Yen, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Ankur Sethi.
Secondary prevention therapy for patients with coronary artery disease using an antiplatelet agent, β-blocker, renin-angiotensin system blocker (RASB), or statin plays an important role in the reduction of coronary events after coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI). We analyzed the status and effects of secondary prevention after coronary revascularization in Taiwan.
This national population-based cohort study was conducted by analyzing the Longitudinal Health Insurance Database 2000 from the National Health Insurance Research Database of Taiwan. Patients who underwent CABG or PCI from 2004 to 2009 were included in the analysis. The baseline characteristics of the patients and ACC/AHA class I medication use at 12 months were analyzed. The primary endpoints were a composite of major adverse cardiac and cerebrovascular events.
A total of 5544 patients comprising 895 CABG and 4649 PCI patients were evaluated. CABG patients had more comorbidities and a higher rate of major adverse event during the follow-up period. However, use of antiplatelet agents and RASB at 12 months was significantly lower in CABG patients than in PCI patients (44.2% vs. 50.9% and 38.6% vs. 48.9%, both p < 0.01). Age, diabetes, and chronic kidney disease were independent risk factors while statin use was a protective factor for the primary endpoints in both PCI and CABG groups. There is still much room to improve class I medication use in secondary prevention for patients after revascularization in Taiwan. Statin could be an effective treatment to improve the outcomes.
Medical therapy is the cornerstone of coronary artery disease (CAD) therapy because coronary revascularization per se does not stop atherosclerosis progression. According to the clinical guidelines for the secondary prevention and risk reduction of CAD, several drugs are strongly recommended to improve outcomes including antiplatelet agents, β-blockers (BB), renin-angiotensin system blockers, and statin [1–2]. However, not all patients receive the recommended drugs after coronary revascularization including percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
The cohort comprised 5544 patients who received coronary revascularization. Among them, 895 underwent CABG and 4649 underwent PCI. The baseline characteristics of both groups are shown in Table 1. Patients who underwent CABG had more comorbidities including DM, hypertension, hyperlipidemia, CKD, and COPD.
There were three major findings in this study. First, evidence-based medicine was still being applied for less than 50% of patients who received revascularization including PCI and CABG at the 12th month in Taiwan. Second, patients who took statin continuously had fewer cardiovascular events in both the PCI and CABG groups. Third, DM and CKD were risk factors for the primary endpoints in both groups.
Much room for improvement in daily practice remains for the secondary prevention of CAD after revascularization in Taiwan. Statin is the most important of 4 ACC/AHA Class I drugs that can improve the outcomes. Physicians should be encouraged to prescribe statin if no contraindication. The benefit of long-term use of 4 ACC/AHA Class I drugs should be educated to all physicians. Furthermore, the control of risk factors including DM, CKD, and COPD is important in Taiwan. Further research is needed to understand the reasons evidence-based medications are not prescribed after CABG or PCI, and to develop appropriate strategies to improve prescription.