n-3 polyunsaturated fatty acids after coronary artery bypass grafting

Background: Despite the robust evidence of the potential benefits of n-3 polyunsaturated fatty acid (PUFA) supplementation in patients with established coronary artery disease, the impact of this therapy on patients after coronary artery bypass grafting remains completely unknown.

Methods: Among 2,100 patients undergoing isolated coronary artery bypass grafting in one tertiary care institution, 930 (44%) were put under n-3 PUFA therapy chronically at discharge. The impact of n-3 PUFAs was assessed by means of propensity-score adjusted analysis. The primary end point was all-cause mortality. Secondary end points were repeat revascularization and the composite of death, Q-wave myocardial infarction, and cerebrovascular events.

Results: In a crude analysis, patients discharged on n-3 PUFAs had a lower risk for late mortality (unadjusted hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.36 to 0.73; p = 0.0002), which was conformed at multivariable adjusted Cox regression analysis (HR, 0.55; 95% CI, 0.26 to 0.90; p = 0.02). Adjusted risk of repeat revascularization was significantly lower in patients receiving n-3 PUFAs than in those who did not (HR, 0.52; 95% CI, 0.28 to 0.97; p = 0.04). The adjusted risk for the composite of death, Q-wave myocardial infarction, or cerebrovascular events was lower in patients who received n-3 PUFAs compared with patients who did not (HR, 0.56; 95% CI, 0.36 to 0.81; p = 0.001). Subgroup analyses showed that mortality benefit associated with n-3 PUFAs was particularly relevant in patients with poor left ventricular function (HR, 0.36; 95% CI, 0.17 to 0.76; p = 0.007), but it was only marginal in patients with good ventricular function (HR, 0.89; 95% CI, 0.65 to 1.01; p = 0.05).

Conclusions: This study showed that n-3 PUFAs after coronary artery bypass grafting were associated with a lower risk for repeat revascularization and overall mortality in patients with poor ventricular function.