Cardioprotective strategies to improve long-term outcomes following coronary artery bypass surgery.
OBJECTIVE
Cardioprotective strategies implemented to prevent ischemic events in patients at risk for cardiovascular disease have decreased morbidity and prolonged survival. In this review, we have used evidence-based medicine and number-needed-to-treat (NNT) analyses to determine which interventions are most beneficial in minimizing ischemic events and prolonging survival following coronary artery bypass graft (CABG) surgery.


METHODS
Therapeutic interventions available to minimize ischemic events in the post-CABG patient were analyzed using ACC/AHA Classifications and Level of Evidence Criteria. Based on these recommendations, NNT analyses were performed to determine the effectiveness of each intervention compared to the number of patients needed to be treated before a benefit was apparent.


RESULTS
The most beneficial intervention to improve mortality following CABG was the use of high tissue angiotensin-converting enzyme inhibitors, followed by statins and smoking cessation.


CONCLUSIONS
NNT analyses and evidence-based medicine recommendations provide surgeons with cardioprotective strategies to improve long-term outcomes following CABG surgery.
Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
Rohit
R
Arora
James R
JR
Sowers
Elijah
E
Saunders
Jeffrey
J
Probstfield
Harold L
HL
Lazar
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D005081:Exercise Therapy; D005500:Follow-Up Studies; D006801:Humans; D017202:Myocardial Ischemia / Q000534:rehabilitation* / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011613:Psychotherapy; D055502:Secondary Prevention; D016540:Smoking Cessation; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants