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Critical Care

, 11:P249 | Cite as

Secondary prevention following surgical revascularisation: continuing under-use of angiotensin-converting enzyme inhibitors

  • A Turley
  • A Thornley
  • A Roberts
  • R Morley
  • W Owens
  • M de Belder
Poster presentation
  • 571 Downloads

Keywords

Coronary Artery Bypass Grafting Coronary Artery Bypass Secondary Prevention Coronary Revascularisation Preventive Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

Over the past decade, coronary revascularisation has helped reduce mortality and morbidity rates from coronary artery disease. In addition to revascularisation, long-term prognosis is dependent on successful implementation of secondary prevention, in particular the use of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and, in many, β-blockers. Previous studies have highlighted the under-utilisation of secondary preventative strategies in this patient population. A focused review of secondary preventative medication at the time of revascularisation provides an excellent opportunity to ensure optimal use of these agents. Our aim was to identify the proportion of patients undergoing nonemergency surgical revascularisation discharged on these four secondary preventative medications.

Methods

A retrospective analysis of our inhouse cardiothoracic surgical database was performed. All patients had undergone surgical revascularisation between January 2003 and November 2006. Only patients undergoing coronary artery bypass grafting were included.

Results

A total of 2,749 consecutive patients were included in the analysis, mean age 65.5 years (± 9.2). In total, 2,302 isolated coronary artery bypass grafting procedures and 447 combined procedures were performed. See Table 1.
Table 1

abstract

 

2003

2004

2005

2006

Total

522

758

767

702

Previous myocardial infarction

296 (56.7%)

364 (48%)

353 (46%)

347 (49.4%)

Left ventricular systolic dysfunction

113 (21.6%)

145 (19.1%)

175 (22.8%)

186 (26.5%)

EuroSCORE

3.8 (2.7)

3.9 (3)

3.9 (2.8)

4.3 (2.9)

Aspirin

490 (93.9%)

694 (91.6%)

700 (91.3%)

652 (92.9%)

ACE inhibitor/angiotensin receptor blocker

285/34 (61%)

421/43 (61%)

430/53 (63%)

382/49 (61%)

β-Blocker

412 (78.9%)

632 (83.4%)

587 (76.5%)

540 (76.9%)

Statin

470 (90%)

700 (92.3%)

710 (92.6%)

638 (90.9%)

Conclusion

Although the utilisation of these preventive therapies has improved compared with previous studies, additional improvements could be made and in particular there is a continuing under-utilisation of ACE inhibitors. There are several reasons why ACE inhibitors might not be used in the early postoperative phase (hypotension, temporary renal dysfunction, etc.). These results reinforce the need to review these patients following recovery from surgery with a view to optimising secondary preventive treatment. This may best be done in community secondary prevention clinics with agreed guidelines.

Copyright information

© BioMed Central Ltd. 2007

Authors and Affiliations

  • A Turley
    • 1
  • A Thornley
    • 1
  • A Roberts
    • 1
  • R Morley
    • 1
  • W Owens
    • 1
  • M de Belder
    • 1
  1. 1.The James Cook University HospitalMiddlesbroughUK

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