Top Things to Know: Secondary Prevention after Coronary Artery Bypass Graft Surgery
Published: February 09, 2015
- Coronary Artery Bypass Surgery (CABG) remains an effective and durable treatment for ischemic heart disease nearly 50 years since its inception.
- Native coronary artery disease and vein graft atherosclerosis increase the risk for ischemic events in CABG patients, necessitating secondary preventive therapies to help maintain native-vessel and graft patency, prevent adverse outcomes, and improve quality of life.
- The purpose of this statement is to report on the current evidence for secondary prevention after CABG, recommend treatment strategies, and identify areas where more research is needed.
- Key postoperative treatment recommendations to reduce graft occlusion and adverse cardiac events include the following:
- Antiplatelet therapy – improves immediate and long-term graft patency
- Statin therapy – controls LDL cholesterol levels and potentially improves endothelial function
- Beta-blocker therapy – reduces hypertension and the risk of postoperative atrial fibrillation
- Strategies to achieve a goal blood pressure of <140/85 mm Hg are outlined for patients following surgery.
- Patients with persistently reduced ejection fraction after CABG may have had a prior myocardial infarction with residual left ventricular dysfunction, requiring individualized tailoring of medications and devices.
- Outpatient, exercise-based cardiac rehabilitation (CR) is recommended for all types of coronary artery disease patients, yet only about a third of CABG patients have even one CR session. Improvements in the referral process and removal of barriers to patient utilization are needed.
- Successful patient self-management of cardiovascular disease risk factors requires intervention through comprehensive outpatient prevention programs designed to improve health-related behavior.
- Additional research is needed to evaluate new pharmacological treatments, the interactions of CABG with secondary risk factors, and the effects of self-management behaviors on outcomes.
- A key message is the need for evidence-based secondary preventive measures to improve outcomes and quality of life for CABG patients.
Citation
Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association [published online ahead of print February 9, 2015]. Circulation. doi: 10.1161/CIR.0000000000000182.