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


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.


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.


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


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.

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Turley, A., Thornley, A., Roberts, A. et al. Secondary prevention following surgical revascularisation: continuing under-use of angiotensin-converting enzyme inhibitors. Crit Care 11 (Suppl 2), P249 (2007).

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