CORRESPONDENCE: LETTER TO THE EDITOR
Cardiac Medical Therapy Following Coronary Artery Bypass Graft Surgery
K.A. Chacko, MD, DM*
* Lakeshore Hospital and Research Hospital, Maradu, Nettoor, Cochin, Kerala 682036, India (Email: chackoka{at}eth.net).
Okrainec et al. (1) meticulously reviewed available data from randomized studies of medical treatment for postcoronary artery bypass graft (CABG) patients. Their recommendations should influence medical practice until further information comes forth in the future.
Patients undergoing CABG at varying intervals after an acute myocardial infarction (MI) are an important subgroup. They are also an important subgroup undergoing percutaneous coronary interventions. The efficacy of beta-blockers (2) and angiotensin-converting enzyme (ACE) inhibitors (3) for secondary prevention after an MI is established. No randomized controlled study has addressed the issue of their usefulness in post-MI patients who have undergone CABG. In the absence of evidence to the contrary, it is prudent to assume that these agents will not lose their efficacy after a post-MI patient undergoes CABG. Therefore, it needs to be stated explicitly that, whereas there is little evidence to suggest that beta-blockers and ACE inhibitors should be used routinely after CABG, they should be used after CABG if the patient had a prior MI. When future studies are planned, distinguishing this subgroup will be important.
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References
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- Okrainec K, Platt R, Pilote L, Eisenberg MJ. Cardiac medical therapy in patients after undergoing coronary artery bypass graft surgery J Am Coll Cardiol 2005;45:177-184.[Abstract/Free Full Text]
- Che CU, Hennekens CH. Beta blockersIn: Hennekens CH, editor. Clinical Trials in Cardiovascular Disease. A Companion to Braunwald’s Heart Disease. Philadelphia, PA: WB Saunders; 1999. pp. 76-94.
- Latini R, Tognoni G, Maggioni AP, et al. Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin: systematic overview of individual data from 96,712 randomized patients. Angiotensin-converting Enzyme Inhibitor Myocardial Infarction Collaborative Group J Am Coll Cardiol 2000;35:1801-1807.[Abstract/Free Full Text]
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