The pathways to increase the efficacy of medication therapy in patients with coronary artery disease after CADG

Abstract

Coronary artery bypass grafting (CABG) remains the main method of surgical treatment of coronary artery disease (CAD) which provides the improvement of quality of life of patients and in severe coronary bed lesion – improvement of prognosis. However, in the long-term period after CABG a poor compliance to the background and antianginal CAD therapy can limit the positive effects of surgical myocardial revascularization.

The purpose of the present research is the estimation of the long-term follow-up stage in patients with CAD during 3-5 years after coronary artery bypass grafting from the position of clinical status, actually taken drug therapy and achievement of treatment targets.

Material and methods. Among 680 patients of the initial sample of CABG registry, 111 men were selected for follow-up and assessment of the taken therapy at the long-term stage. The selected patients were hospitalized in 2011 with the clinical signs of stable CAD to perform a complete myocardial revascularization by the method of coronary artery bypass grafting (CABG) with cardiopulmonary bypass. The mean age was 61 (55;65) years. Statistical processing of the research results was made using SPSSStatistics version 22.0.0.0 software of IBM Corporation (USA).

Results. After 3-5 years, the prognosis (alive/dead status) was estimated in 111 patients according to Civil Registry Office database. The mean value of the follow-up period was 4.2 years. The mortality rate was 11.7 % (n=13): in 11 cases – cardiovascular mortality and in 2 cases – mortality from the undetermined causes. The endpoints, defined as repeated hospitalizations and CAD progression, were revealed in 18 out of 98 examined patients (18.4%). Only a quarter of the patients didn’t have clinical signs of angina pectoris within 3-5 years after CABG. In 5 (5.1%) patients a new onset type 2 diabetes mellitus was registered. Enteric coated acetylsalicylic acid was taken by 80 (81.6%) patients, angiotensin-converting enzyme inhibitor – 60 (61.2%), beta-blockers – 80 (81.6%) and statins were taken by 81 (82.6%) patients. However, high-intensity statins (rosuvastatin 20-40 mg, atorvastatin 40 mg) were taken only by 20 (20.4%) out of 98 re-examined patients. Target values of low-density lipoproteins (LDL) less than 1.8 mmol/l were registered only in 7 patients (7.1%). In more than 80% of cases, the patients were taken bisoprolol in low and medium dosage (2.5-10 mg) as a beta-blocker. None of the patients had prescribe dbeta-blockers in maximum therapeutic dosage. Target heart rate in stable angina (55-60 beats/min) was achieved only in 12 (12.2%) patients. Target values of arterial blood pressure (SBP<140 mmHg) were achieved in 64 (65.3%) and (DBP<90 mmHg) 69 (70.4%) patients.

Conclusion. Real clinical practice data shows the insufficient quality of the background and antianginal therapy in patients with CAD after CABG. The indicators of control of anginal attacks, heart rate and achievement of lipid profile target values remain unsatisfactory.