Missing the Goal with the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization

2023 ACC/AHA Chronic Coronary Disease Guideline - An opportunity to reestablish coronary artery bypass recommendations

Coronary artery bypass (CABG) has evolved over the decades, supported by scientific evidence from robust studies. The downgrade of the recommendation for CABG in patients with multivessel coronary artery disease proposed by the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization and the 2023 ACC/AHA Chronic Coronary Disease Guidelines has brought this discussion to the fore, with prestigious cardiothoracic surgery societies such as AATS and STS not supporting these recommendations. The purpose of this article is to broaden this discussion in light of published studies.

Less Invasive and Hybrid Surgical/Interventional Coronary Disease Management: The Future Is Now

Coronary artery bypass grafting (CABG) has evolved to become the criterion standard in elective revascularisation for coronary artery disease (CAD), particularly in patients with complex or multivessel CAD, left main involvement, diabetes mellitus, or left ventricular dysfunction. Despite the superiority of CABG in patients with the most advanced forms of CAD, a standard CABG operation, through a median sternotomy and with the use of cardiopulmonary bypass, carries well recognised challenges. In this article, we describe newer approaches, such as off-pump CABG, minimally invasive bypass grafting, robotic CABG, and hybrid coronary revascularisation, which we consider as necessary ways to minimise invasion, reduce recovery time, provide the benefits of arterial grafting to more patients, and offer alternatives to mitigate the adverse effects of conventional sternotomy and cardiopulmonary bypass.

Exploring the effect of music therapy as intervention to reduce anxiety pre- and post-operatively in CABG surgery: A quantitative systematic review

AIM

Patients undergoing coronary artery bypass graft (CABG) surgery may experience psychological complications, which can increase mortality. This review aims to explore the efficacy of music therapy as an intervention to reduce anxiety pre- and post-operatively in CABG surgery.

DESIGN

This was a quantitative systematic review registered in PROSPERO (REDACTED).

METHODS

This review used the PECOD framework to identify quantitative questions. We systematically searched seven electronic databases (Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PubMed, Embase, PsycArticles, and PsycInfo) for articles published between 1 January 1992 and 13 July 2022. Studies were critically appraised, and the results of this systematic review yielded a narrative summary of the findings.

RESULTS

Four randomized control trials and one quasi-experimental study published in English were included in the review. Narrative analysis indicated that patients undergoing CABG who were assigned to the group receiving music therapy reported significantly reduced anxiety levels compared with controls who did not listen to music. In addition, music therapy can effectively be used as a non-pharmacological intervention to manage anxiety pre- and post-operatively in CABG surgery. No members of the public or patients were involved in the design or conduct of the study.