Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association.

Nearly 400 000 coronary artery bypass graft surgery (CABG) procedures are performed annually in the United States.1 A proven therapy for nearly 50 years, CABG is the most durable and complete treatment of ischemic heart disease. However, in the months and years that follow surgery, patients who have undergone CABG remain at risk for subsequent ischemic events as a result of native coronary artery disease (CAD) progression and the development of vein graft atherosclerosis. Secondary therapies therefore play a key role in the maintenance of native and graft vessel patency and in the prevention of adverse cardiovascular outcomes. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention after coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation (CR). Secondary preventive therapies help maintain long-term graft patency and help patients obtain the highest level of physical health and quality of life after CABG. This scientific statement seeks to expand on two 2011 American Heart Association (AHA) and American College of Cardiology Foundation (ACCF) documents that provided a general overview of secondary prevention2 and briefly summarized the use of medical therapy after surgical coronary revascularization.3 Since the writing of these 2 statements, important evidence from clinical and observational trials has emerged that further supports and broadens the merits of intensive risk-reduction therapies for CABG patients. The purpose of this scientific statement, specifically focused on the CABG population, is to thoroughly evaluate the current state of evidence on preventive therapies after surgery. In addition to providing revised and updated recommendations on the use of secondary preventive therapies after CABG, this statement highlights areas in need of prospectively collected clinical trial data. Comprehensive risk factor management reduces …