P187 - ELIGIBILITY FOR ICOSAPENT ETHYL THERAPY AND LONG-TERM CARDIOVASCULAR OUTCOMES IN PATIENTS UNDERGOING ISOLATED CORONARY ARTERY BYPASS GRAFTING SURGERY

Background: Results from the REDUCE-IT trial suggest that icosapent ethyl (IPE) can decrease the risk of cardiovascular (CV) events in patients with a history of coronary artery bypass grafting (CABG) surgery. We sought to evaluate the proportion of patients undergoing isolated CABG surgery eligible for enrolment in REDUCE-IT, their comparative CV outcomes and the potential impact of IPE therapy in this surgical population.

METHODS AND RESULTS: Prospectively collected data from 14,232 consecutive patients undergoing isolated CABG in a single institution between 2002-2017 were reviewed. CV outcomes were retrieved from a provincial registry with 100% complete follow-up.
A total of 3,431 (24%) patients met the inclusion criteria for REDUCE-IT (ELIGIBLE cohort). Reasons for REDUCE-IT ineligibility included triglyceride levels < 1.52 (59.1%) or >5.65 mmol/l (0.6%), LDL-cholesterol levels < 1.06 (9.1%) or >2.59 mmol/l (22.3%), and non-optimal statin therapy (9.0%). Compared to the rest of the cohort, ELIGIBLE patients were younger (64.68.7 vs 66.29.1 years, p< 0.0001), with a similar proportion of males (78.5 vs 79.9%, p=0.09), a higher prevalence of diabetes (38.8 vs 27.7%, p< 0.0001) and higher proportion of patients on statin therapy (100 vs 88.0%, p< 0.0001). At a mean follow-up of 8.64.7 years, age-, diabetes- and statin use-adjusted rate of the composite endpoint of CV death, non-fatal unstable angina/myocardial infarction (UA/MI) and non-fatal stroke was significantly higher for the ELIGIBLE cohort (4.5 vs 4.0 events per 100 patients-year (PY), p< 0.001). This was mainly due to a significantly increased risk of recurrent UA/MI (2.1 vs 1.9 events per 100 PY, p=0.04) and a trend towards an increased risk of stroke (0.8 vs 0.7 events per 100 PY, p=0.09), while CV death was not significantly different (0.76 vs 0.70 events per 100 PY, p=0.25). There also was a trend for a higher rate of rehospitalisation for non-CV causes (8.6 vs 8.3 events per 100 PY, p=0.12) in ELIGIBLE patients. Based on the REDUCE-IT trial results and length of follow up, 892 composite endpoint events could have been prevented with IPE therapy over a 4.9-year period in our 3,241-patient ELIGIBLE cohort.


Conclusion: One in four patients undergoing isolated CABG surgery meet the REDUCE-IT criteria for eligibility to IPE therapy. These patients are at significantly higher risk of CV events postoperatively. With its demonstrated 26% relative risk reduction in composite CV complications, IPE should be strongly considered for post-CABG secondary prevention in eligible patients.