Impact of Statin Use on Outcomes After Coronary Artery Bypass Graft Surgery

Abstract

Background-The benefits of statins have been demonstrated for patients with a remote history of coronary artery bypass grafting (CABG); however, no investigation to date has evaluated whether initiation of statin therapy in the early months after surgery improves clinical outcomes. Methods and Results-A retrospective cohort of 7503 Medicare patients Ն65 years of age who underwent CABG (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) was assembled by use of linked hospital and pharmacy claims data. Rates of all-cause mortality and major adverse cardiovascular events were compared between patients who were (nϭ1745) and were not (nϭ5788) prescribed statins within 1 month of CABG discharge. Additional analyses evaluated the impact of statin initiation between 1 and 6 months after surgery. Multivariable and propensity score analysis demonstrated that statin use within 1 month of CABG discharge independently reduced the risk of all-cause mortality (adjusted hazard ratio 0.82, 95% confidence interval 0.72 to 0.94) compared with no statin use. Similarly, statin use within 1 month of CABG discharge independently reduced the risk of major adverse cardiovascular events (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.98). Initiation of statin therapy between 1 and 6 months after CABG discharge was also associated with reductions in major adverse cardiovascular events and mortality; however, outcome rates between early (Յ1 month after CABG) and delayed (1 to 6 months after CABG) statin initiation were not significantly different. Conclusions-Statin therapy initiated in the early months after hospital discharge independently reduces all-cause mortality and major adverse cardiovascular events after CABG. These findings validate the widespread practice of prescribing long-term statin therapy after CABG. (Circulation. 2008;118:1785-1792.)

Statins Reduce Short‐ and Long‐Term Mortality Associated With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Impact of Postoperative Atrial Fibrillation and Statin Therapy on Survival

“…13,19,23,24,27 As in some other large observational studies, 25,26 we did not find a significant association between statin therapy and operative mortality. However, in this study, statin therapy was associated with a protective effect against both operative and long-term mortality in the subset of patients who developed POAF.…”

Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery

“…4 After surgery, these agents lower rates of mortality and adverse cardiovascular events. [4][5][6][7] Notwithstanding these benefits, adherence to preventative medical therapy after CABG remains low. 3,8,9 Poor adherence to evidence-based medications leads to a rise in healthcare costs 17 and significantly increases the risk of MI and death after CABG.…”

Compliance with pharmacological treatment among patients after minimally invasive coronary bypass grafting

“…Also, we found a correlation between ingestion of antiplatelet agents and BB, and the need for readmission. Compliant individual less frequently experienced hospitalization compared to patients indifferent to pharmacotherapy, hence we assume that pharmacological interventions help improve patients' outcome and reduce costs for the healthcare system [21][22][23][24][25][26]. Although our study failed to demonstrate a statistically significant link between patients' clinical features and drug compliance, we managed to denote considerable prevalence of the issue of therapeutic non-adherence and its clinical implications.…”