CABG Guidelines Get New Update

Hormone replacement out, aspirin in, as cardiology experts change the rules for coronary artery bypass graft surgery

(Bethesda, MD) The American College of Cardiology (ACC) and the American Heart Association (AHA) have issued a revised set of guidelines for the management of patients undergoing coronary artery bypass grafting. In contrast to the previous guidelines published in 1999, the new update says no to hormone replacement therapy and yes to aspirin for patients undergoing this common surgical procedure.

The new guidelines also stress the importance of statin and beta blocker therapy in all post-CABG patients, as well as anticoagulation with warfarin in patients who develop sustained abnormal heart rhythms after bypass. The document is published on the Web sites of the American College of Cardiology at http://www.acc.org/clinical/guidelines/cabg/index.pdf and the American Heart Association www.americanheart.org and will appear in the September 1 issue of the Journal of the American College of Cardiology and the August 31 issue of the Circulation: Journal of the American Heart Association.

We've significantly updated a number of sections of the 1999 guidelines to incorporate the most recent evidence from randomized trials. One important example is in the area of hormone replacement. Until the randomized trials were published, we were generally recommending the initiation of hormone therapy in women after their bypass, but in this document, it is not recommended at all, said Dr. Kim Eagle, co-chair of the guidelines writing committee.