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Introduction: Diabetes is associated with a higher risk of major adverse coronary events (MACE) following coronary artery bypass grafting (CABG). Guidelines recommend disparate targets for glycemic control of patients with diabetes who have undergone CABG, ranging from a target hemoglobin A1c (HbA1c) of < 7.0% to 7.1–8.5%, based on data from non‐CABG patients. To date, no study has evaluated the long‐term impact of HbA1c concentrations on MACE post‐CABG. Objective: To evaluate the association between HbA1c and MACE in CABG patients with diabetes. Methods: A secondary analysis of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI2D) trial, which enrolled patients with type 2 diabetes and coronary artery disease, restricted to participants who underwent CABG with ≥ 1 HbA1c measurement post‐CABG, was performed. The index date was date of first post‐CABG HbA1c measurement. The primary outcome was MACE (composite of death, myocardial infarction, unstable angina, or repeat revascularization). Secondary outcomes included MACE components and heart failure. Cox proportional hazards models treating HbA1c as a time‐dependent exposure (reference group: HbA1c 6.1–7.0%) were used to derive hazard ratios (HRs) with 95% confidence intervals adjusting for age, sex and baseline characteristics selected by stepwise regression. Results: A total of 549 patients were followed over a median 3.5 years. The median age of the cohort was 64 years, 25.1% were female, and median baseline HbA1c was 6.7%. Compared to achieving an HbA1c 6.1‐7.0%, HbA1c > 8.0% was associated with an increased risk of MACE (HR 1.77, 1.01–3.10). This association was strongest for unstable angina (HR 5.21, 1.03–26.39). Achieving an HbA1c ≤ 6.0% was associated with an increased risk of death (HR 2.41, 1.01–5.74). Other comparisons were not statistically significant. Conclusion: Among patients with type 2 diabetes who underwent CABG, achieving HbA1c 6.1–7.0% was associated with a lower risk of MACE and unstable angina versus achieving an HbA1c > 8.0% and lower risk of death versus achieving an HbA1c ≤ 6.0%. [ABSTRACT FROM AUTHOR]

Study Objective To determine the rate of secondary prevention cardiovascular drug utilization in a cohort of patients who underwent coronary artery bypass graft ( CABG) surgery-including specific drugs and their dosages, drug adherence, and assessment of targeted therapy-from admission to 1 year after CABG surgery. Design Retrospective analysis. Setting Cardiovascular quaternary care medical center in Edmonton, Canada. Patients The entire cohort consisted of 1031 adults who underwent CABG surgery between January 2009 and March 2010; a randomly selected subset of 151 patients was used to evaluate medication use and target-directed therapy at 1 year after CABG surgery. Measurements and Main Results Utilization rates of aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers ( ACEIs/ ARBs) on admission and at discharge were determined for the entire cohort by using data from a large clinical patient registry. The proportion of patients discharged receiving all four classes of medications was 35%. Individual utilization rates for aspirin, β-blockers, and statins were 96%, 94%, and 95%, respectively; use of ACEIs/ ARBs was lowest at 42%. In the 1-year post- CABG surgery substudy, medication use and target-directed therapy at 1 year after CABG surgery were evaluated by using community pharmacy and electronic health records. The proportion of patients receiving all four classes of medications at 1 year was 48%. Individual utilization rates for aspirin, β-blockers, statins, and ACEIs/ ARBs were 95%, 84%, 84%, and 65%, respectively. Medication adherence, assessed by the medication possession ratio, for β-blockers, statins, and angiotensin-modulating agents at 1 year exceeded 0.85, thereby demonstrating high adherence. Evaluation of target-directed treatment of dyslipidemia and diabetes mellitus demonstrated suboptimal control, with only 66% and 54% of patients, respectively, achieving the recommended therapeutic targets. Conclusion The utilization rate for patients receiving all four classes of secondary prevention cardiovascular medications was 35% at discharge and 48% at 1 year after CABG surgery. These rates were primarily limited by the low utilization of angiotensin-modulating agents, although their rate improved by 22% from discharge. Utilization rates, however, were high for aspirin, β-blockers, and statins both at discharge and 1 year after surgery. Opportunities remain to further optimize secondary prevention cardiovascular pharmacotherapy in patients who undergo CABG surgery, either while in the hospital or immediately subsequent to discharge. [ABSTRACT FROM AUTHOR]