What is the appropriate care after Coronary Artery Bypass Grafting (CABG)?

From the Guidelines

Care after coronary artery bypass grafting (CABG) should prioritize lifelong aspirin therapy, as well as consideration of dual antiplatelet therapy (DAPT) in selected patients, to optimize graft patency and reduce the risk of adverse cardiovascular events, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1.

Key Components of Care after CABG

• Patients should take all prescribed medications, including aspirin (81-325mg daily) indefinitely, to reduce the risk of graft occlusion and adverse cardiovascular events 1.
• Statins should be prescribed to lower cholesterol, beta-blockers to control heart rate, and ACE inhibitors if they have reduced heart function or diabetes, as these medications have been shown to improve outcomes after CABG 1.
• Pain management typically involves acetaminophen and possibly short-term opioids, transitioning to over-the-counter options as healing progresses.
• Wound care is essential, including keeping incisions clean and dry, watching for signs of infection like redness or drainage, and attending follow-up appointments for sternal wire and suture removal.

Lifestyle Modifications and Cardiac Rehabilitation

• Cardiac rehabilitation should begin 2-4 weeks after surgery, gradually increasing physical activity under professional guidance, as recommended by the American Heart Association 1.
• Lifestyle modifications are crucial, including smoking cessation, heart-healthy diet, weight management, and stress reduction, to reduce the risk of adverse cardiovascular events and improve overall health.
• Patients should monitor for complications such as fever, chest pain, shortness of breath, or wound issues, seeking immediate medical attention if these occur.

Recovery and Return to Activity

• Recovery typically takes 6-12 weeks, with driving resumed after 4-6 weeks and return to work based on job demands and surgeon recommendations.
• A comprehensive approach to care after CABG, including medication management, lifestyle modifications, and cardiac rehabilitation, promotes healing, prevents complications, and supports long-term heart health after CABG surgery.

From the Research

Care after CABG

• The care after Coronary Artery Bypass Grafting (CABG) involves the use of various medications to prevent complications and improve long-term outcomes 2, 3.
• Statins and aspirin are essential medications that should be continued indefinitely after CABG, unless contraindications exist, as they have been shown to improve outcomes and reduce the risk of graft failure 2.
• Beta blockers, such as carvedilol and metoprolol, are also used to prevent atrial fibrillation after CABG, with carvedilol being more effective than metoprolol in some studies 4, 5.
• Long-term use of beta blockers after CABG has been associated with improved outcomes, including reduced risk of major adverse cardiovascular events (MACEs) and myocardial infarction (MI) 6.

Medication Use after CABG

• A study found that only 67% of patients were prescribed a statin and 75% were prescribed aspirin after CABG, with only 52% being prescribed both medications 2.
• Another study found that ongoing treatment with cardioselective beta blockers after CABG was associated with a reduction in MACEs, mainly due to reduced long-term risk for MI 6.
• The use of dual antiplatelet therapy with clopidogrel is less convincing, but newer antiplatelet agents, such as ticagrelor, may offer benefits 3.

Patient Outcomes after CABG

• Patients who were prescribed a statin after CABG had significantly lower mean low-density lipoprotein (LDL) and total cholesterol values compared to those not prescribed a statin 2.
• The incidence of postoperative atrial fibrillation was lower in patients treated with carvedilol compared to metoprolol 4, 5.
• Ongoing treatment with cardioselective beta blockers after CABG was associated with a reduction in MACEs, mainly due to reduced long-term risk for MI, in patients with and without previous MI, heart failure, atrial fibrillation, or reduced left ventricular ejection fraction (LVEF) 6.