THE PATHWAYS TO INCREASE THE EFFICACY OF DRUG THERAPY IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS GRAFTING

Purpose: to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3-5 years of follow-up after coronary bypass surgery. Materials and methods. From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass grafting (CABG). Results. Mean duration of follow-up was 4.2 years. Mortality was 11.7% (n=13), 11 deaths were cardiovascular, 2 - from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4%). Only in 25% of patients during 3-5 years of observation after CABG there were no clinical signs of angina. Five patients (5.1%) developed new type 2 diabetes. Drug therapy: 80 patients (81.6%) received acetylsalicylic acid, 60 (61.2%) - angiotensin converting enzyme inhibitors, 80 (81.6%) - beta-adrenoblockers. Eighty-one men (82.6%) received statins, but only 20 of 98 re-examined patients (20.4%) took high doses. Target levels of low density lipoprotein cholesterol (<1.8 mmol/l) were registered only in (7 patients 7.1%). As beta-adrenoblocker more than in 80% of cases patients took bisoprolol in low or medium doses. None of the patients received maximal therapeutic dose of a beta-adrenoblocker. Target heart rate for stable angina (55-60 bpm) was achieved in 12 patients (12.2%). Target levels of systolic and diastolic blood pressure (<140 and <90 mm Hg) achieved 64 and 69 patients (63.5 and 65.3%), respectively. Conclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD after CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.