Post-CABG Care

Question 1

What glucose level should be maintained following CABG?

Answer 1

100-140, use an insulin drip.

Question 2

What did the ATACAS Trial show regarding perioperative ASA in CABG?

Answer 2

ASA given 1-2 hrs prior to surgery Vs placebo 1-2 hrs prior to surgery, there was no significant difference in rate of death / nonfatal MI / Stroke / PE / Renal Failure.

No significant difference in rate of major hemorrhage.

Question 3

Despite the ATACAS Trial, what is the outcome for patients that recieve ASA within 48 hrs following CABG?

Answer 3

Pts given ASA within 48 hrs of CABG, had significant decrease in subsequent (after 48 hrs post-surgical) in-hospital mortality, MI, Stroke, or Acute Renal Failure.

Question 4

What is the 2015 AHA stance on pre-operative ASA?

Answer 4

“ASA should be started or continued pre-operatively for CABG.”

Question 5

Are there any current recommendation for Plavix prior to CABG and following CABG?

Answer 5

If the CABG is elective –> stop the Plavix 5-7 days prior to surgery.

For patients NOT on plavix prior to CABG, there is difference in practice, some CT doctors will Rx Plavix (or P2Y12 Inhibitors) for 12 months similar to PCI (DES), while others will NOT Rx Plavix.

Question 6

What is the Survival Rate post-CABG per the ASCERT Trial of 2012?

Answer 6

180 day mortality = 6.4%
1 yr mortality = 8.1%
2 yr mortality = 11.3%
3 yr mortality = 23.3%

More than 350,000 pts, all >/= 65 years old.

Question 7

What patients should be referred to Cardiac Rehab?

Answer 7

1) PCI / CABG (ie: anyone underwent revascularization)
2) ACS
3) Stable Angina with known CAD

These are all Grade IA recommendations for referral

Additionally, pts with CHF or PAD can also be referred to Cardiac Rehab.

Question 8

What aspects are addressed at Cardiac Rehab?

Answer 8

1) Exercise Regimen
2) Medication Compliance
3) Diet
4) Smoking Cessation
5) Psycho-Social Counseling.