JTCVS open · 2025
Discharge prescription patterns in multiarterial versus single-arterial coronary artery bypass grafting: A regional multicenter cohort analysis.
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Scheffel Emily C, Weber Matthew P, Ridley Lauryn A, Noona Sean W W, Young Steven D, El Moheb Mohamad, Strobel Raymond, Young Andrew, Singh Ramesh, Joesph Mark, Yount Kenan, Quader Mohammed, Teman Nicholas, Beller Jared P
Аннотация
OBJECTIVE: Medical management after multiarterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG) is less characterized. We sought to identify discharge prescription patterns after CABG on the basis of conduit selection.
METHODS: This retrospective study included patients from a 17-institution regional collaborative undergoing isolated CABG from 2020 to 2023. Patients were stratified into MAG and SAG cohorts. Primary analysis included dual antiplatelet therapy (DAPT), anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker discharge prescription rates. Multivariable logistic regression was executed to assess independent associations.
RESULTS: The cohort included 10,966 patients (8904 SAG, 2062 MAG). Patients in the SAG group were significantly older with a median age of 67 years [61, 74] versus 61 years [55, 68] in the MAG cohort. Patients in the SAG group were more likely to present with non-ST-segment elevation myocardial infarction (34.1% vs 31.0%, P < .01) and greater Society of Thoracic Surgeons predicted risk of mortality (1.1% vs 0.7%, P < .01). Patients in the MAG group were more likely to be prescribed DAPT (51.2% vs 70.6%, P < .01), amiodarone (54.2% vs 66.7%, P < .01) and less likely to be prescribed any anticoagulants (12.7% vs 9.1%, P < .01), warfarin (3.2% vs 1.5%, P < .01) or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (24.6% vs 19.8%, P < .01). After risk adjustment, MAG was independently associated with DAPT (odds ratio, 1.69 [1.4-2.0], P < .01).
CONCLUSIONS: Patients undergoing MAG are more likely to be prescribed DAPT at discharge, independent of clinical presentation and baseline comorbidities. Differences in postrevascularization medications between patients who receive MAG and SAG differ and should be considered when comparing groups and outcomes.
METHODS: This retrospective study included patients from a 17-institution regional collaborative undergoing isolated CABG from 2020 to 2023. Patients were stratified into MAG and SAG cohorts. Primary analysis included dual antiplatelet therapy (DAPT), anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker discharge prescription rates. Multivariable logistic regression was executed to assess independent associations.
RESULTS: The cohort included 10,966 patients (8904 SAG, 2062 MAG). Patients in the SAG group were significantly older with a median age of 67 years [61, 74] versus 61 years [55, 68] in the MAG cohort. Patients in the SAG group were more likely to present with non-ST-segment elevation myocardial infarction (34.1% vs 31.0%, P < .01) and greater Society of Thoracic Surgeons predicted risk of mortality (1.1% vs 0.7%, P < .01). Patients in the MAG group were more likely to be prescribed DAPT (51.2% vs 70.6%, P < .01), amiodarone (54.2% vs 66.7%, P < .01) and less likely to be prescribed any anticoagulants (12.7% vs 9.1%, P < .01), warfarin (3.2% vs 1.5%, P < .01) or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (24.6% vs 19.8%, P < .01). After risk adjustment, MAG was independently associated with DAPT (odds ratio, 1.69 [1.4-2.0], P < .01).
CONCLUSIONS: Patients undergoing MAG are more likely to be prescribed DAPT at discharge, independent of clinical presentation and baseline comorbidities. Differences in postrevascularization medications between patients who receive MAG and SAG differ and should be considered when comparing groups and outcomes.