Impact of functional testing results on prescription patterns of anti-anginal medication after coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

BACKGROUND: Although coronary artery bypass graft surgery (CABG) is known to reduce angina, previous studies have suggested that anti-anginal medication use is not significantly reduced after CABG. However, it is unclear how functional testing results have an impact on anti-anginal medication prescription patterns. OBJECTIVES: To determine whether post-CABG functional testing results impact prescription patterns of anti-anginal medication during the 12 months after CABG. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter study. We examined anti-anginal medication use (beta blockers, calcium channel blockers and nitrates) at discharge and at 12 months post-CABG with respect to functional testing results among 392 patients. RESULTS: Among the 392 patients, 146 had at least one functional test over the 12-month follow up period. Among the 146 patients, 17% had positive functional tests, 69% had negative tests, and 14% had indeterminate tests. Both beta blocker and calcium channel blocker use did not increase from discharge to 12 months following a positive test (N ≤ 25) (84% vs. 80%; p ≤ NS; 16% vs. 16%; p ≤ NS), while nitrate use increased seven-fold (4% vs. 28%; p ≤ 0.03). However, following a negative test (N ≤ 100), beta blocker use only decreased modestly (85% vs. 70%; p ≤ 0.01), while both calcium channel blocker and nitrate use were unchanged (30% vs. 20%; p ≤ NS; 4% vs. 6%; p ≤ NS, respectively). Following an indeterminate test (N ≤ 21), anti-anginal medication use was unchanged (p ≤ NS for all 3 classes of medication). CONCLUSION: The use of anti-anginal medication is only modestly reduced after CABG, and functional testing results during the first year post-CABG do not have a strong impact on prescription patterns of anti-anginal agents.