Guidelines: Coronary Artery Bypass Grafting
Posted by Clark Venable on 12/15/2004
Guidelines updated for Coronary Artery Bypass Grafting (CABG):
" "Key Points
- Off-pump CABG, which avoids aortic cannulation and cardiopulmonary bypass, is now available in many hospitals. However, three randomized trials comparing neurologic outcomes after off-pump and on-pump CABG provide insufficient evidence to warrant the conclusion that the off-pump procedure is better for limiting neurologic complications.
- The authors note that long-term data from trials of angioplasty versus CABG (most notably the BARI trial) continue to show significant advantages with CABG for preventing death and repeat revascularization in diabetes patients.
- Since 1999, both stent use and left internal mammary-artery grafting have become more common. The most recent randomized trial data show that rates of death, MI, and stroke remain similar for CABG recipients compared with stent recipients. The authors also mention that CABG's advantage over stenting for preventing repeat revascularization has narrowed, but remains significant.
- In a class I recommendation, the authors write that aspirin is "the drug of choice" for prophylaxis against early saphenous-vein graft closure and should be continued indefinitely.
- There is a new class I recommendation for statin therapy in all CABG patients, unless contraindicated.
- Hormone replacement therapy should no longer be initiated in women after CABG.
- The new guidelines emphasize the importance of understanding how newer antithrombotic and antiplatelet therapies affect bleeding risk in acute coronary syndrome patients who undergo CABG. For example, the authors have made a class I recommendation that clopidogrel be withheld for 5 days before CABG, if clinical circumstances permit.
- Several new sections have been added, including those about off-pump techniques, robotic coronary bypass, and the value of clinical guidelines and pathways for guiding postoperative care and improving outcomes." "
[Via Medscape Headlines]
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