2015AHA科学声明：冠状动脉旁路移植术后的二级预防

1. Coronary Artery Bypass Surgery (CABG) remains an effective and durable treatment for ischemic heart disease nearly 50 years since its inception.

2. Native coronary artery disease and vein graft atherosclerosis increase the risk for ischemic events in CABG patients, necessitating secondary preventive therapies to help maintain native-vessel and graft patency, prevent adverse outcomes, and improve quality of life. 

3. The purpose of this statement is to report on the current evidence for secondary  prevention after CABG, recommend treatment strategies, and identify areas where more  research is needed.

4. Key postoperative treatment recommendations to reduce graft occlusion and adverse  cardiac events include the following:

• Antiplatelet therapy – improves immediate and long-term graft patency 

• Statin therapy – controls LDL cholesterol levels and potentially improves endothelial function

• Beta-blocker therapy – reduces hypertension and the risk of postoperative atrial fibrillation

5. Strategies to achieve a goal blood pressure of <140/85 mm Hg are outlined for patients following surgery.

6. Patients with persistently reduced ejection fraction after CABG may have had a prior myocardial infarction with residual left ventricular dysfunction, requiring individualized  tailoring of medications and devices. 

7. Outpatient, exercise-based cardiac rehabilitation (CR) is recommended for all types of  coronary artery disease patients, yet only about a third of CABG patients have even one CR session. Improvements in the referral process and removal of barriers to patient utilization are needed.

8. Successful patient self-management of cardiovascular disease risk factors requires intervention through comprehensive outpatient prevention programs designed to improve health-related behavior.

9. Additional research is needed to evaluate new pharmacological treatments, the interactions of CABG with secondary risk factors, and the effects of self-management behaviors on outcomes.

10.A key message is the need for evidence-based secondary preventive measures to improve outcomes and quality of life for CABG patients.