Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial

Background-The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of 2 lipid-lowering regimens and low-dose anticoagulation vers us placebo on progression of atherosclerosis in saphenous vein grafts of pa tients who had had CABG surgery, demonstrated that aggressive lowering of L DL cholesterol (LDL-C) levels to <100 mg/dL compared with a moderate reduct ion to 132 to 136 mg/dL decreased the progression of atherosclerosis in gra fts. Low-dose anticoagulation did not significantly affect progression. Methods and Results-Approximately 3 years after the last trial visit, Clini cal Center Coordinators contacted each patient by telephone to ascertain th e occurrence of cardiovascular events and procedures. The National Death In dex was used to ascertain vital status for patients who could not be contac ted, Vital status was established for all but 3 of 1351 patients. Informati on on nonfatal events was available for 95% of surviving patients. A 30% re duction in revascularization procedures and 24% reduction in a composite cl inical end point were observed in patients assigned to aggressive strategy compared with patients assigned to moderate strategy during 7.5 years of fo llow-up, P=0.0006 and 0.001, respectively. Reductions of 35% in deaths and 31% in deaths or myocardial infarctions with low-dose anticoagulation compa red with placebo were also observed, P=0.008 and 0.003, respectively. Conclusions-The long-term clinical benefit observed during extended follow- up in patients assigned to the aggressive strategy is consistent with the a ngiographic findings of delayed atherosclerosis progression in grafts obser ved during the trial. The apparent long-term benefit of low-dose warfarin r emains unexplained.