Guideline Video

Guideline Resources

  • Secondary Prevention After Coronary Artery Bypass Graft Surgery
  • American Heart Association
  • May 13, 2026
  • Summary
  • Full-text

Video Transcription

Just published May 13th, 2026, the American Heart Association’s newest scientific statement update on Secondary Prevention After Coronary Artery Bypass Graft Surgery.

This statement incorporates new evidence and practical considerations related to secondary prevention after coronary artery bypass grafting, also known as CABG.

In today’s rapid update, we’ll just be going over a summary of the practical considerations that were added to this 2026 update. For the full scientific statement, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Practical Considerations for Antithrombotic Therapy After CABG

  • Low-dose aspirin initiated within 6 hours after CABG and continued indefinitely improves graft patency and reduces future cardiovascular events.
  • In patients with acute coronary syndrome (ACS) undergoing CABG, dual antiplatelet therapy (DAPT) for 1 year may be associated with a lower risk of death and cardiac events.
  • In patients with chronic coronary disease, routine DAPT is not indicated.

Next the section on Practical Considerations for Lipid Management After CABG

  • Treat to an LDL-C threshold of 55 mg/dL as an ideal target and to no higher than 70 mg/dL as an established target. 
  • First-line therapy: High-intensity or maximally tolerated statin therapy aimed at achieving LDL-C target levels.
  • Second-line therapy: If the LDL-C target is not achieved with statins alone, ezetimibe.
  • Third-line therapy: If the combination of statin and ezetimibe still fails to achieve the target, PCSK9 inhibitor, or consider icosapent ethyl if the triglyceride level is between 135 mg/dL and 500 mg/dL.

Moving on to the section on Practical Considerations for β-Blocker Therapy After CABG

  • Preoperative: No evidence supports β-blocker administration within 24 hours before elective CABG in β-blocker–naive patients.
  • Perioperative: β-blockers are used to prevent atrial fibrillation (AF) in high-risk patients. If already on β-blockers, perioperative continuation is associated with a reduction in AF.
  • Long term: Cardioselective β-blockers after CABG are associated with lower rates of major adverse cardiovascular events (MACEs) but no reduction in mortality.

Next the section on Practical Considerations for Antihypertensive Therapy After CABG

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blocker (ARBs) are indicated for patients who have a clinical indication other than CABG.
  • The use of calcium channel blockers for the first postoperative year may help limit radial artery graft spasm.

For the section on Practical Considerations for Previous MI and Left Ventricular Dysfunction Management After CABG

  • In those with previous MI and persistent LVEF <40%, use of an angiotensin receptor-neprilysin inhibitor (ARNi) is considered first line. 
  • Device therapy: An implantable cardioverter defibrillator is indicated for primary prevention of sudden cardiac death ≥40 days after MI or ≥90 days after revascularization in patients with LVEF <35% and with NYHA class II to III heart failure on GDMT, LVEF ≤30% on GDMT and LVEF ≤40% and inducible sustained ventricular tachycardia or ventricular fibrillation. 

Moving on to the section on Practical Considerations for Diabetes Management After CABG

For long-term secondary prevention:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors are prioritized in patients with diabetes and a history of CABG regardless of baseline HbA1c. SGLT2 inhibitors are prioritized in patients after CABG with heart failure regardless of diabetes status or ejection fraction. 
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are prioritized in post-CABG patients with diabetes or a BMI >27 kg/m2 without diabetes to reduce MACEs regardless of HbA1c.GLP-1 RAs are prioritized in people with diabetes and concomitant peripheral artery disease to improve functional outcomes and to prevent disease progression.

For perioperative considerations:

  • SGLT2 inhibitors should be avoided in people with type 1 diabetes.
  • When clinically appropriate, SGLT2 inhibitors should be withheld 3 days before CABG and restarted once oral intake has been initiated postoperatively to reduce the risk of diabetic ketoacidosis.
  • When clinically appropriate, once-weekly GLP-1 RAs should be stopped 1 week before surgery and oral GLP-1 RAs should be stopped 3 days before surgery and resumed when the patient is eating well and bowel motility is restored.

Now the section on Practical Considerations for Smoking Cessation After CABG

  • The cardiac surgeon should document smoking status, actively counsel on the importance of smoking cessation, and initiate smoking cessation support preoperatively. 
  • As with other chronic diseases, longitudinal smoking cessation care benefits from ongoing management by general practitioners or tobacco treatment specialists.

On to the section on Practical Considerations for Cardiac Rehabilitation (CR) and Exercise After CABG

  • All patients with chronic coronary artery disease (CAD) and appropriate indications should be referred to CR programs within 4 weeks of discharge to improve outcomes.
  • CR for patients who are undergoing CABG is most robust when it begins preoperatively, continues during hospitalization, and extends into outpatient care.
  • Telerehabilitation offers a flexible and accessible alternative for delivering CR, particularly for older adults or those unable to attend center-based programs.

Next the section on Practical Considerations for Other Cardiovascular Risk Reduction After CABG

  • In addition to diet and exercise, behavioral weight loss programs emphasize the importance of health behavior change incorporating self-efficacy, goal setting, stimulus control, and stress management and may be incorporated when obesity is present.
  • Effective strategies may target a net negative energy balance through exercise prescriptions that maximize caloric expenditure and dietary counseling to reduce energy intake.
  • Evidence supports the role of pharmacotherapy in achieving meaningful weight loss and reducing MACEs in both patients with and those without diabetes.
  • Influenza and pneumococcal vaccines should be considered in individuals with atherosclerotic cardiovascular disease. Vaccinations for all adults should be discussed and tailored to individual risk profiles.

And last, the section on Practical Considerations for Mental Health Management After CABG

  • It is essential to assess psychosocial risk factors and mood disturbance through clinical interviews or with standardized tools before and after surgery.
  • Targeted interventions to address depression and anxiety may be implemented per established standards. 
  • Cardiac prehabilitation and CR programs enhance physical health and alleviate symptoms of depression, anxiety, and hostility.
  • Systematic screening for preexisting conditions can identify frailty and inform personalized rehabilitation strategies, improving outcomes and adherence to secondary prevention after CABG.

And there you have it. Make sure to check out the full statement from the American Heart Association and other related clinical decision support tools at guidelinecentral.com.

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