• Yaron Moshkovitz, Liat Orenstein, Liraz Olmer, Keren Laufer, Arnona Ziv, and Rachel Dankner.
• Department of Cardiothoracic Surgery, Assuta Hospital, Tel Aviv, affiliated to the Faculty of Heath Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
• Mayo Clin. Proc. 2024 May 1; 99 (5): 766779766-779.

ObjectivesTo explore admission and discharge prescription rates of guideline-directed medical therapy (GDMT), defined as aggregate antiplatelet agents, statins, and β-blockers, after coronary artery bypass graft (CABG) surgery and to reveal its association with long-term survival.Patients And MethodsThis is a prospective cohort study-based emulated trial of patients undergoing elective or semi-elective isolated CABG surgery in 7 cardiothoracic units in Israel from January 1, 2004, to December 31, 2007, and followed up until December 31, 2020, for all-cause mortality.ResultsOnly 59.2% of 968 patients (n=573) were discharged on GDMT after CABG surgery. Admission GDMT use conferred a 7 times greater likelihood of discharge GDMT prescription (odds ratio, 7.07; 95% CI, 5.04 to 9.91; P<.001), with no sex differences observed. After applying inverse probability of treatment weighting, baseline characteristics were well balanced between groups. During a median follow-up of 13.7 years, a Cox regression model with propensity score-adjusted inverse probability of treatment weighting revealed lower mortality in patients with discharge GDMT prescription who underwent CABG surgery than in their counterparts (hazard ratio, 0.75; 95% CI, 0.60 to 0.93; P=.008).ConclusionThe use of aggregate GDMT before surgery conferred a greater likelihood of GDMT prescription upon discharge, which, in turn, is associated with better long-term survival. Educational efforts of pertinent medical professionals are needed to minimize preventive treatment gaps.Trial Registrationclinicaltrials.gov Identifier: NCT00356863.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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