Coronary artery bypass surgery management of hyperlipidemia

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Patient Information

Overview

Pathophysiology

Saphenous Vein Graft Disease
Other Non-Atherosclerotic Saphenous Vein Graft Diseases

Indications for CABG

Prognosis

Diagnosis

Imaging in the Patient Undergoing CABG

Chest X Ray

Angiography

CT Angiography
MRI Angiography

Trans-Esophageal Echocardiography

Treatment

Goals of Treatment

Perioperative Management

Perioperative Monitoring

Electrocardiographic Monitoring
Pulmonary Artery Catheterization
Central Nervous System Monitoring

Surgical Procedure

Anesthetic Considerations
Intervention in left main coronary artery disease
The Traditional Coronary Artery Bypass Grafting Procedure (Simplified)
Minimally Invasive CABG
Hybrid coronary revascularization
Conduits Used for Bypass
Videos on Spahenous Vein Graft Harvesting
Videos on Coronary Artery Bypass Surgery

Post-Operative Care and Complications

Recommendation for Duration of DAPT in Patients With ACS Treated With CABG

Special Scenarios

Anomalous Coronary Arteries
COPD/Respiratory Insufficiency
Existing Renal Disease
Concomitant Valvular Disease
Previous Cardiac Surgery
Menopause
Carotid Disease evaluation before surgery

Coronary artery bypass surgery management of hyperlipidemia On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

Management of Hyperlipidemia (DO NOT EDIT)[1]

Class I
"1. All patients undergoing CABG should receive statin therapy, unless contraindicated.[2][3][4][5][6][7][8][9][10][11][12][13][14] (Level of Evidence: A)"
"2. In patients undergoing CABG, an adequate dose of statin should be used to reduce LDL cholesterol to less than 100 mg/dL and to achieve at least a 30% lowering of LDL cholesterol.[3][4][5][6][7] (Level of Evidence: C)"
Class III: HARM
"1. Discontinuation of statin or other dyslipidemic therapy is not recommended before or after CABG in patients without adverse reactions to therapy.[15][16][17] (Level of Evidence: B)"
Class IIa
"1. In patients undergoing CABG, it is reasonable to treat with statin therapy to lower the LDL cholesterol to less than 70 mg/dL in very high-risk* patients.[4][5][6][18][19][20] (Level of Evidence: C)"
"2. For patients undergoing urgent or emergency CABG who are not taking a statin, it is reasonable to initiate high-dose statin therapy immediately.[21] (Level of Evidence: C)"
* Presence of established cardiovascular disease plus 1) multiple major risk factors (especially diabetes), 2) severe and poorly controlled risk factors (especially continued cigarette smoking), 3) multiple risk factors of the metabolic syndrome (especially high triglycerides ≥200 mg/dL plus non–high-density lipoprotein cholesterol ≥130 mg/dL with low high-density lipoprotein cholesterol <40 mg/dL), and 4) acute coronary syndromes.

References

  1. 1.0 1.1 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. "The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. The Post Coronary Artery Bypass Graft Trial Investigators". The New England Journal of Medicine. 336 (3): 153–62. 1997. doi:10.1056/NEJM199701163360301. PMID 8992351. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  3. 3.0 3.1 "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. 2002. PMID 12485966. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 4.2 Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R (2010). "Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials". Lancet. 376 (9753): 1670–81. doi:10.1016/S0140-6736(10)61350-5. PMC 2988224. PMID 21067804. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 5.2 Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I, Larsen ML, Bendiksen FS, Lindahl C, Szarek M, Tsai J (2005). "High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial". JAMA : the Journal of the American Medical Association. 294 (19): 2437–45. doi:10.1001/jama.294.19.2437. PMID 16287954. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 6.2 LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK (2005). "Intensive lipid lowering with atorvastatin in patients with stable coronary disease". The New England Journal of Medicine. 352 (14): 1425–35. doi:10.1056/NEJMoa050461. PMID 15755765. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  7. 7.0 7.1 "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial". Lancet. 360 (9326): 7–22. 2002. doi:10.1016/S0140-6736(02)09327-3. PMID 12114036. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  8. Dotani MI, Elnicki DM, Jain AC, Gibson CM (2000). "Effect of preoperative statin therapy and cardiac outcomes after coronary artery bypass grafting". The American Journal of Cardiology. 86 (10): 1128–30, A6. PMID 11074212. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  9. Mannacio VA, Iorio D, De Amicis V, Di Lello F, Musumeci F (2008). "Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial". The Journal of Thoracic and Cardiovascular Surgery. 136 (6): 1541–8. doi:10.1016/j.jtcvs.2008.06.038. PMID 19114204. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  10. Liakopoulos OJ, Choi YH, Haldenwang PL, Strauch J, Wittwer T, Dörge H, Stamm C, Wassmer G, Wahlers T (2008). "Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients". European Heart Journal. 29 (12): 1548–59. doi:10.1093/eurheartj/ehn198. PMID 18506053. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  11. Knatterud GL, Rosenberg Y, Campeau L, Geller NL, Hunninghake DB, Forman SA, Forrester JS, Gobel FL, Herd JA, Hickey A, Hoogwerf BJ, Terrin ML, White C (2000). "Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG Investigators". Circulation. 102 (2): 157–65. PMID 10889125. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  12. Christenson JT (1999). "Preoperative lipid-control with simvastatin reduces the risk of postoperative thrombocytosis and thrombotic complications following CABG". European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery. 15 (4): 394–9, discussion 399–400. PMID 10371111. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  13. Pascual DA, Arribas JM, Tornel PL, Marín F, Oliver C, Ahumada M, Gomez-Plana J, Martínez P, Arcas R, Valdes M (2006). "Preoperative statin therapy and troponin T predict early complications of coronary artery surgery". The Annals of Thoracic Surgery. 81 (1): 78–83. doi:10.1016/j.athoracsur.2005.07.038. PMID 16368340. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  14. Pan W, Pintar T, Anton J, Lee VV, Vaughn WK, Collard CD (2004). "Statins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery". Circulation. 110 (11 Suppl 1): II45–9. doi:10.1161/01.CIR.0000138316.24048.08. PMID 15364837. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  15. Collard CD, Body SC, Shernan SK, Wang S, Mangano DT (2006). "Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery". The Journal of Thoracic and Cardiovascular Surgery. 132 (2): 392–400. doi:10.1016/j.jtcvs.2006.04.009. PMID 16872968. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  16. Kulik A, Brookhart MA, Levin R, Ruel M, Solomon DH, Choudhry NK (2008). "Impact of statin use on outcomes after coronary artery bypass graft surgery". Circulation. 118 (18): 1785–92. doi:10.1161/CIRCULATIONAHA.108.799445. PMID 18852363. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  17. Thielmann M, Neuhäuser M, Marr A, Jaeger BR, Wendt D, Schuetze B, Kamler M, Massoudy P, Erbel R, Jakob H (2007). "Lipid-lowering effect of preoperative statin therapy on postoperative major adverse cardiac events after coronary artery bypass surgery". The Journal of Thoracic and Cardiovascular Surgery. 134 (5): 1143–9. doi:10.1016/j.jtcvs.2007.07.029. PMID 17976441. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  18. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM (2004). "Intensive versus moderate lipid lowering with statins after acute coronary syndromes". The New England Journal of Medicine. 350 (15): 1495–504. doi:10.1056/NEJMoa040583. PMID 15007110. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  19. Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E (2006). "Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy". Journal of the American College of Cardiology. 48 (3): 438–45. doi:10.1016/j.jacc.2006.04.070. PMID 16875966. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  20. Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines". Circulation. 110 (2): 227–39. doi:10.1161/01.CIR.0000133317.49796.0E. PMID 15249516. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  21. Safety Alert. Zocor (simvastatin) increased risk of muscle injury with high doses. U.S. Department of Health and Human Services. Retrieved on 2011-12-14

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