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.