Analysis of drug therapy and achievement of target parameters in patients with stable coronary artery disease before elective myocardial revascularization

To evaluate the quality of preoperative preparation in patients with stable coronary artery disease (CAD) hospitalized for elective myocardial revascularization, including an analysis of the rate of achievement of target blood pressure (BP), heart rate (HR), and low-density lipoprotein cholesterol (LDL-C) levels, as well as a comparison of these parameters depending on the chosen intervention method (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG).

Material and Methods. The study included 300 patients with a verified diagnosis of stable coronary artery disease who were indicated for planned myocardial revascularization between January 2025 and February 2026. The severity of coronary disease was assessed using the SYNTAX Score, and the functional class of angina was assessed using the Canadian Cardiology Society (CCS) classification. Selection criteria for PCI were: single- or two-vessel disease without involvement of the left main coronary artery (LMCA), SYNTAX Score ≤ 22. Selection criteria for CABG were: multivessel disease (≥ 3 vessels), LMCA stenosis > 50% or its equivalent, SYNTAX Score ≥ 23. The cohort was divided into two groups: PCI – 193 patients (64.3%), CABG – 107 patients (35.7%). The study design was a cross-sectional observational study. The data source was a specialized block registry containing 107 structured parameters. An analysis was conducted of prescribed drug therapy and the frequency of achieving target levels of blood pressure (< 130/80 mmHg), heart rate (55–60 bpm for patients with sinus rhythm), and LDL-C (< 1.4 mmol/L). Results. High coverage of the main classes of cardiotropic drugs was revealed (statins – 90%, beta-blockers – 90%, angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers – 87.6%). Target blood pressure was achieved by 82% of patients, with no significant differences between groups. The average heart rate was 70.4 bpm, with no patients (0%) achieving the target level of 55–60 bpm. Only 30% of patients achieved the target LDL-C level < 1.4 mmol/L, with this figure significantly lower in the CABG group (21.5% versus 34.7% in the PCI group, p < 0.001). The addition of ezetimibe increased the proportion of patients with the target LDL-C level from 33.3% to 47.6%. The presence of patients not receiving antiplatelet therapy was identified (up to 14% in the PCI group).

Conclusion. Current drug therapy in patients with stable coronary artery disease before planned revascularization is characterized by high coverage, but insufficient intensification to achieve strict targets. The worst situation is observed in the group of the most severe patients (candidates for CABG), which requires optimization of preoperative preparation.

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