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Suboptimal Medical Therapy After Coronary Revascularization
Despite the benefits of coronary revascularization, patients with severe coronary artery disease (CAD) continue to be at risk for ischemic events in the months and years that follow coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).
Secondary prevention therapies play a key role in the management of patients with advanced CAD by helping avert future adverse cardiovascular outcomes, slowing the progression of native CAD, and inhibiting the development of native and graft atherosclerosis.
Antiplatelet therapies are the mainstay of secondary prevention, with aspirin and P2Y12 inhibitors administered to prevent stent thrombosis and bypass graft occlusion, as well as improve event-free survival in patients with severe CAD.
Statins also are indicated after coronary revascularization, with extensive evidence supporting their benefits in reducing the progression of native CAD, improving bypass graft patency, and lowering the risk of adverse cardiovascular events.
For patients with extensive CAD and previous myocardial infarction, beta-blockers reduce the risk of death and recurrent events, and in the surgical population, their administration can lower the risk of new-onset atrial fibrillation after CABG.
Lastly, numerous studies have shown that angiotensin-converting enzyme inhibitors help improve cardiovascular outcomes for patients with CAD, particularly in those with a history of myocardial infarction, heart failure, diabetes mellitus, or renal dysfunction.
These 4 classes of medications form the bulk of pharmacologic secondary prevention for patients with advanced CAD, and given the benefits of these medications, current clinical guidelines recommend that nearly all coronary revascularization patients be considered candidates for the long-term administration of these agents.
