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Hillis et al 2011 ACCF/AHA CABG Guideline e731

Appendix 1. Author Relationships With Industry and Other Entities (Relevant)—2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

						Institutional,		Voting
				Ownership/		Organizational, or		Recusals by
Committee				Partnership/	Personal	Other Financial		Section
Member	Employer/Title	Consultant	Speaker’s Bureau	Principal	Research	Benefit	Expert Witness	Numbers*
L. David	University of Texas Health	None	None	None	None	None	None	None
Hillis (Chair)	Science Center at San
	Antonio—Professor and
	Chair of the Department of
	Medicine
Peter K.	Duke University Medical	• Eli Lilly	None	None	None	None	None	2.2.3
Smith (Vice	Center: Private Diagnostic	• Baxter BioSurgery						4.1
Chair)	Clinic—Professor of							4.2
	Surgery; Chief of Thoracic							5.2.6
	Surgery
Jeffrey L.	Intermountain Medical	• BMS/sanofi-aventis	None	None	• AstraZeneca	None	None	2.1.6
Anderson	Center—Associate Chief of				• Gilead Pharma			2.2.3
	Cardiology				• Toshiba†			4.1
								4.2
								4.3
								5.2.6
John A. Bittl	Ocala Heart Institute	None	None	None	None	None	None	None
	Munroe Regional Medical
	Center—Interventional
	Cardiologist
Charles R.	University of Pennsylvania	• Baxter BioSurgery†	• Bayer	None	None	None	• Plaintiff, alleged mitral	2.2.3
Bridges	Medical Center—Chief of	• Zymogenetics	Pharmaceuticals				valve dysfunction, 2009	4.1
	Cardiothoracic Surgery						• Defendant, retinal artery	4.2
							occlusion (stroke) after	5.2.6
							CABG, 2009
							• Defendant, timely
							insertion of IABP after
							CABG, 2009
							• Defendant, timely
							transport after acute
							aortic dissection, 2009
							• Plaintiff, unexpected
							intra-abdominal
							hemorrhage and death
							after AVR, 2009
John G.	Vanderbilt University	None	None	None	None	None	None	None
Byrne	Medical Center: Division of
	Cardiac
	Surgery—Chairman of
	Cardiac Surgery
Joaquin E.	Oregon Health and	None	None	None	None	None	None	None
Cigarroa	Science
	University—Associate
	Professor of Medicine
Verdi J.	John Hopkins Hospital,	None	None	None	None	None	None	None
DiSesa	Division of Cardiac
	Surgery—Clinical
	Associate
Loren F.	Cardiac, Vascular and	None	None	None	None	None	None	None
Hiratzka	Thoracic Surgeons,
	Inc.—Medical Director of
	Cardiac Surgery
Adolph M.	Massachusetts General	None	None	None	None	None	None	None
Hutter, Jr.	Hospital—Professor of
	Medicine
Michael E.	UT Southwestern Medical	• Quest Medical†	None	None	None	None	None	2.1.8
Jessen	Center—Professor of
	Cardiothoracic Surgery
Ellen C.	University of	None	None	None	None	None	None	None
Keeley	Virginia—Associate
	Professor of Internal
	Medicine
Stephen J.	University of	None	None	None	None	None	• Defendant, mitral valve	None
Lahey	Connecticut—Professor						replacement, 2009
	and Chief of
	Cardiothoracic Surgery

(Continued)

e732	Circulation		December 6, 2011
Appendix 1.		Continued
							Institutional,		Voting
					Ownership/		Organizational, or		Recusals by
Committee					Partnership/	Personal	Other Financial		Section
Member		Employer/Title	Consultant	Speaker’s Bureau	Principal	Research	Benefit	Expert Witness	Numbers*
Richard A.	University of Texas Health		None	None	None	None	None	None	None
Lange		Science Center at San
		Antonio—Professor of
		Medicine
Martin J.	University of California San		None	None	None	None	None	None	None
London	Francisco, Veterans Affairs
	Medical Center—Professor
		of Clinical Anesthesia
Michael J.	The Heart Hospital Baylor		• Cordis	None	None	None	None	None	2.1.3
Mack		Plano—Cardiovascular	• Marquett						2.2.1
	Surgery, Medical Director		• Medtronic						5.2.1.1
			• Edwards Lifesciences†						5.2.1.2
Manesh R.		Duke University Medical	None	None	None	None	None	None	None
Patel		Center—Associate
		Professor of Medicine
John D.		Emory University/Emory	• Marquett	None	None	• Marquett‡	None	None	2.1.3
Puskas		Healthcare—Chief of	• Medtronic			• Medtronic‡			2.2.1
		Cardiac Surgery							2.2.2
Joseph F.		Cleveland Clinic	• Edwards Lifesciences	None	None	None	None	None	2.2.2
Sabik	Foundation—Professor of		• Medtronic						5.2.1.1
		Surgery							5.2.1.2
Ola Selnes		John Hopkins Hospital,	None	None	None	None	None	None	None
		Department of
		Neurology—Professor of
		Neurology
David M.		Massachusetts General	None	None	None	None	None	None	None
Shahian		Hospital—Professor of
		Surgery
Jeffrey C.		John Hopkins School of	None	None	None	• Toshiba‡	None	None	2.1.7
Trost		Medicine—Assistant							4.10
		Professor of Medicine							4.10.1
									4.10.2
									4.10.3
									5.2.1.1.1
									5.2.1.1.2
Michael D.		University of Mississippi	None	None	None	None	None	None	None
Winniford	Medical Center—Professor
		of Medicine

This table represents the relationships of committee members with industry and other entities that were determined to be relevant to this document. These relationships were reviewed and updated in conjunction with all meetings and/or conference calls of the writing committee during the document development process. The table does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% of the voting stock or share of the business entity, or ownership of $10 000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. Relationships that exist with no financial benefit are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted.

According to the ACCF/AHA, a person has a relevant relationship IF: (a) The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or (b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or (c) the person or a member of the person’s household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.

*Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply.

†No financial benefit. ‡Significant relationship.

AVR indicates aortic valve replacement; CABG, coronary artery bypass graft surgery; and IABP, intraaortic balloon pump.

Hillis et al 2011 ACCF/AHA CABG Guideline e733

Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant)—2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

						Institutional,
				Ownership/		Organizational, or
				Partnership/		Other Financial
Peer Reviewer	Representation	Consultant	Speaker’s Bureau	Principal	Personal Research	Benefit	Expert Witness
Robert Guyton	Official	None	None	None	• Edwards	None	None
	Reviewer—ACCF/				Lifesciences
	AHA Task Force on
	Practice Guidelines
Jeffrey Jacobs	Official	None	None	None	None	None	None
	Reviewer—ACCF/
	AHA Task Force on
	Data Standards
L. Kristin	Official	• AstraZeneca	None	None	• Eli Lilly*	None	None
Newby	Reviewer—AHA				• GlaxoSmithKline†
Eric D.	Official	• AstraZeneca	None	None	• BMS/sanofi-aventis†	None	None
Peterson	Reviewer—ACCF/				• Eli Lilly†
	AHA Task Force on
	Performance
	Measures
Richard J.	Official	• Edwards	None	None	None	None	None
Shemin	Reviewer—AHA	Lifesciences
Hector Ventura	Official	None	• Actelion	None	None	None	None
	Reviewer—ACCF		• Gilead
	Board of Governors
Thad F. Waites	Official	None	None	None	None	None	None
	Reviewer—ACCF
	Board of Trustees
T. Bruce	Organizational	None	None	None	None	None	None
Ferguson, Jr	Reviewer—STS
Stephen E.	Organizational	None	None	None	None	Merck	• Defendant, leaking
Fremes	Reviewer—AATS						thoracic aortic
							aneurysm, 2009
							• Defendant, aortic
							dissection, 2009
Colleen G.	Organizational	None	None	None	None	None	None
Koch	Reviewer—SCA
Harold L.	Organizational	None	None	None	None	None	None
Lazar	Reviewer—AATS
Walter H.	Organizational	None	None	None	None	None	None
Merrill	Reviewer—STS
Stanton K.	Organizational	None	• Philips Healthcare	None	None	None	• Plaintiff, communication
Shernan	Reviewer—SCA						of echocardiography
							results, 2010
Joseph S.	Content Reviewer	• Bayer	None	None	None	None	None
Alpert		• Sanofi-aventis
Robert M.	Content Reviewer	• AstraZeneca	None	None	• Eli Lilly†	None	None
Califf		• Daiichi-Sankyo			• Bayer
		• GlaxoSmithKline
		• Medtronic
		• Sanofi-aventis
Robbin G.	Content Reviewer	None	None	None	None	None	• Defendant, death after
Cohen							minimally invasive heart
							surgery, 2011
							• Defendant, diagnosis of
							aortic dissection, 2010
							• Plaintiff, renal failure
							and Aprotinin, 2010
Mark A.	Content	• AstraZeneca	None	None	• Merck	None	• Plaintiff, Fasudil
Creager	Reviewer—ACCF/	• Genzyme					Development: Asahi
	AHA Task Force on	• Merck					Pharma v Actelion,
	Practice Guidelines	• Roche					2010
		• Vascutek
							(Continued)

e734	Circulation		December 6, 2011
Appendix 2.		Continued
							Institutional,
					Ownership/		Organizational, or
					Partnership/		Other Financial
Peer Reviewer		Representation	Consultant	Speaker’s Bureau	Principal	Personal Research	Benefit	Expert Witness
Steven M.		Content	None	None	None	• Medtronic	None	None
Ettinger		Review—ACCF/AHA
		Task Force on
		Practice Guidelines
David P. Faxon		Content Reviewer	• Sanofi-aventis	None	None	None	None	• Defendant, cath
								vascular access site
								complication, 2009
Kirsten E.		Content Reviewer	None	None	None	None	None	None
Fleischmann
Lee Fleisher		Content Reviewer	None	None	None	• Pfizer	• AstraZeneca†	• Defendant, perioperative
								stroke, 2009
Anthony P.		Content	None	None	None	None	None	• Defendant, Bayer Corp.
Furnary		Reviewer—ACCF						Trasylol litigation,
		Surgeons’ Scientific						2009 to 2011
		Council
Valentin Fuster		Content Reviewer	None	None	None	None	None	None
John W.		Content Reviewer	• GlaxoSmithKline	None	None	None	None	None
Hirshfeld, Jr
Judith S.		Content	• Eli Lilly	None	None	None	None	None
Hochman		Reviewer—ACCF/	• GlaxoSmithKline
		AHA Task Force on
		Practice Guidelines
James L.		Content Reviewer	• Roche	None	None	• Roche	None	None
Januzzi, Jr
Frederick G.		Content	None	None	None	None	None	None
Kushner		Reviewer—Vice
		Chair, 2012 STEMI
		Guideline Writing
		Committee
Glenn Levine		Content	None	None	None	None	None	None
		Review—Chair,
		2011 PCI Guideline
		Writing Committee
Donald Likosky		Content Reviewer	None	None	None	• Maquet†	None	None
						• Medtronic†
James J.		Content	None	None	None	None	None	• Defendant, acute aortic
Livesay		Reviewer—Southern						dissection, 2011
		Thoracic Surgical						• Defendant, cardiac
		Association						mortality review, 2010
								• Defendant, heparin
								induced
								thrombocytopenia, 2010
Bruce W. Lytle		Content	None	None	None	None	None	None
		Reviewer—2004
		CABG Guideline
		Writing Committee
Robert A.		Content	None	None	None	None	None	None
Marlow		Reviewer—2004
		CABG Guideline
		Writing Committee
Rick A.		Content	None	None	None	None	None	None
Nishimura		Reviewer—ACCF
		Board of Trustees
Patrick O’Gara		Content	None	None	None	None	None	None
		Reviewer—Chair,
		2012 STEMI
		Guideline Writing
		Committee

(Continued)

				Hillis et al	2011 ACCF/AHA CABG Guideline			e735
Appendix 2.	Continued
						Institutional,
				Ownership/		Organizational, or
				Partnership/		Other Financial
Peer Reviewer	Representation	Consultant	Speaker’s Bureau	Principal	Personal Research	Benefit	Expert Witness
E. Magnus	Content	• AstraZeneca	• Boehringer	None	• Daiichi-Sankyo	None	None
Ohman	Reviewer—ACCF/	• Bristol-Myers	Ingelheim		• Datascope
	AHA Task Force on	Squibb	• Gilead Sciences		• Eli Lilly
	Practice Guidelines	• Boehringer
		Ingelheim
		• Gilead Sciences
		• Merck
		• Pozen
		• Sanofi-aventis
John D.	Content Reviewer	None	None	None	None	None	None
Rutherford
George A.	Content Reviewer	None	None	None	None	None	• Defendant, review of
Stouffer							malpractice claim, 2010
Mathew	Content—ACCF	• Edwards	None	None	None	None	None
Williams	Interventional	Lifesciences
	Scientific Council	• Medtronic

This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant. It does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% of the voting stock or share of the business entity, or ownership of $10 000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. A relationship is considered to be modest if it is less than significant under the preceding definition. Relationships that exist with no financial benefit are also included for the purpose of transparency. Relationships in this table are modest unless otherwise noted. Names are listed in alphabetical order within each category of review.

According to the ACCF/AHA, a person has a relevant relationship IF: (a) The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or (b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or (c) the person or a member of the person’s household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.

*No financial benefit. †Significant relationship.

AATS indicates American Association for Thoracic Surgery; ACCF, American College of Cardiology Foundation; AHA, American Heart Association; CABG, coronary artery bypass graft surgery; PCI, percutaneous coronary intervention; SCA, Society of Cardiovascular Anesthesiologists; STEMI, ST-elevation myocardial infarction; and STS, Society of Thoracic Surgeons.

Appendix 3. Abbreviation List

ACE angiotensin-converting enzyme	LIMA left internal mammary artery
ACS acute coronary syndrome	LV left ventricular
AF atrial fibrillation	LVEF left ventricular ejection fraction
AKI acute kidney injury	MACE major adverse coronary events
ARB angiotensin-receptor blockers	MI myocardial infarction
BMS bare-metal stent	NSTEMI non-ST-elevation myocardial infarction
CABG coronary artery bypass graft surgery	PAC pulmonary artery catheter
CAD coronary artery disease	PAD peripheral artery disease
CKD chronic kidney disease	PCI percutaneous coronary intervention
CPB cardiopulmonary bypass	RCT randomized controlled trial
DAPT dual antiplatelet therapy	SIHD stable ischemic heart disease
DES drug-eluting stent	SIRS systemic inflammatory response system
EF ejection fraction	STEMI ST-elevation myocardial infarction
GDMT guideline-directed medical therapy	SVG saphenous vein graft
ICU intensive care unit	TEE transesophageal echocardiography
IMA internal mammary artery	TIA transient ischemic attack
LAD left anterior descending	TMR transmyocardial laser revascularization
LDL low-density lipoprotein	UA unstable angina

Correction

In the article by Hillis et al, “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,” which published ahead of print on November 7, 2011, and appears in the December 6, 2011, issue of the journal (Circulation. 2011;124:e652– e735), a correction was needed.

On page e689, in the second column, under “5.2.2. Mediastinitis/Perioperative Infection: Recommendations,” the second recommendation under Class I read,

2.A second-generation cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.897–905 (Level of Evidence: A)

It has been changed to read,

2.A firstor second-generation cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.897–905

(Level of Evidence: A)

This correction has been made to the current online version of the article, which is available at http://circ.ahajournals.org/cgi/reprint/124/23/e652.

DOI: 10.1161/CIR.0b013e318242d5c8

(Circulation. 2011;124:e957.)

© 2011 American Heart Association, Inc.

Circulation is available at http://circ.ahajournals.org

e957

2011 ACCF/AHA Coronary Artery Bypass Graft Surgery Data Supplements

Data Supplement 1. Anesthetic Considerations

Author	Drug	Number of	Number of		RR (95% CI)	P-Value		Mortality	RR	P-Value	Number of	RR	P-Value	Sternal	RR	P-Value
		Patients	patients with				Number of		(95% CI)		Patients	(95%		Infection in	(95% CI)
				≥1 SAE			Patients (%)				with CV	CI)		Patients (%)
				(%)							events (%)
Ott et. al.	Standard Care	151	15	(9.9)			0	(0)			4 (2.6)			0 (0)
2003 (1)
	Parecoxib/vald	311	59	(19.0)		0.015	4	(1.3)		0.31	17 (5.4)			10 (3.2)		0.035
	ecoxib
Nussmeier et	Placebo	560	22	(4.0)			1	(0.2)			3 (0.5)			16 (2.9)
al. 2005 (2)
	Placebo+Vald	556	40	(7.4)	1.9 (1.1 to	0.02	3	(0.6)	3.0 (0.3 to	0.31	6 (1.1)	2.0 (0.5	0.31	27 (5.0)	1.7 (0.9 to 3.3)	0.08
	ecoxib				3.2)				29.3)			to 8.1)
	Parecoxib/vald	555	40	(7.4)	1.9 (1.1 to	0.02	4	(0.7)	4.1 (0.5 to	0.18	11 (2.0)	3.7 (1.0	0.03	20 (3.7)	1.3 (0.7 to 2.5)	0.48
	ecoxib				3.2)				36.4)			to 13.5)
	Both COX-2	1,088	1,088 (7.4)		2.9 (0.8 to	0.08	7	(0.6)	3.6 (0.4 to	0.2	17 (1.6)	2.9 (0.8	0.08	47 (4.3)	1.5 (0.8 to 2.7)	0.15
	Groups				9.9)				29.1)			to 9.9)

CI indicates confidence interval; COX-2; cyclooxygenase-2 inhibitors; CV, cardiovascular; N, number of patients; RR, relative risk; and SAE, serious adverse events.

Data Supplement 2. Preconditioning: Table 1

Author	Study Population	Comparison	Protocol	Primary Outcome	Comments
De Hurt et al. 2009 (3)	Elective CABG, 8 centers	TIVA only n=145; SEVO	Minimum end-tidal volatile	Peak postoperative troponin T release:	Only variable associated with elevated troponin
	Belgium, 2002 to 2004	n=132; DES n=137	concentration 0.5 MAC starting at least	TIVA 0.30 ng/ml (0.00 to 4.79); SEVO	was use of >2 distal anastomoses; volatile
			30 min prior to cross-clamping	0.33 ng/ml (0.02 to 3.68);	assignment associated with shorter LOS; only
			continued until at least 10 min after the	DES 0.39 ng/ml (0.08 to 3.74); p=NS	significant predictor of 1 y mortality was
			release of the cross-clamp on CPB	between groups	EUROSCORE >2
			otherwise anesthesia not controlled
© American College of Cardiology Foundation and American Heart Association, Inc.

Frassdorf et al 2009 (4)	Elective CABG, single center	TIVA only n=10,	10 min prior to CPB onset, SEVO	Peak postoperative tropronin I release:	Translocation of PKC epsilon observed in SEVO
		SEVO group I n=10,	group I received 1.0 MAC SEVO for 5	TIVA only 14±3 ng/ml;	group II from cytosol to nuclear fraction
		SEVO group II n=10	min;	SEVO group I 14±3 ng/ml; SEVO	consistent with preconditioning
			SEVO group II received (2 times) 5	group II group 7±2 ng/ml;
			min of SEVO, with 5 min washout 10	TIVA only and SEVO group I vs.
			min before CPB.	SEVO group II; p<0.001
Flier 2010 (5)	Elective CABG, single center	Group I: n=51; Group P:	Group I: ISO 0.5 to 1.0 MAC with SUF	Peak postoperative troponin I release:	No differences in in-hospital mortality or
		n=49	Group P: PROP 2 to 4 mg/kg/h with	Group I: 2.72 mg/ml (95% CI: 1.78 to	morbidity, 1 y-mortality
			SUF throughout surgery	5.85) vs. Group P: 2.64 mg/ml (95%
				CI: 1.67 to 4.83); p=0.11

CI, confidence interval; CPB indicates cardiopulmonary bypass; CV, cardiovascular; DES, desflurane; EUROSCORE, European System for Cardiac Operative Risk Evaluation; ISO, isoflurane; LOS, length of stay; MAC, minimum alveolar concentration; NS, non significant; PKC, protein kinase C; PROP, propofol; RCT, randomized controlled trial; RR, relative risk; SEVO, sevoflurane; SUF, sufentanil; and TIVA, total intravenous anesthesia.

Data Supplement 3. Preconditioning: Table 2

Author

Study Population

Study

Proposed

Patients With

%

Patients With

%

ARR

RR

95% CI

P-Value

Comments

Drug

Mechanism

Event/Total

Event/Total

Patients for

Patients

Placebo

Treated

Mangano et al.

Subanalysis of 2 y

Acadesin

Purine analog

Death 15/54

Death

Death 3/46

Death 6.5%

Death 0.213

Death

Death

Death 0.013

Subsequent large scale RCT:

2006 (6)

outcome of 100

e

increases local

Periop MI

27.8%

Periop MI

Periop MI

Periop MI

0.765

0.239 to

MI 0.53

RED-CABG (Effect of

patients sustaining

adenosine

54/1358

Periop MI

46/1337

3.4%

0.005

Periop

0.928

Acadesine on Reducing

perioperative MI

levels, inhibit

4.0%

MI 0.135

Periop MI

Cardiovascular and

in larger RCT

mPTP opening

0.273 to

Cerebrovascular Adverse

(Acadesine Trial

0.412

Events in Coronary Artery

1024 conducted in

Bypass Graft)

2,695 CABG

(NCT00872001) with

patients at 54

planned enrollment of 7,500

centers from 1993

patients was terminated for

to 1994 evaluating

futility by sponsor Oct. 2010

efficacy in

reduction of

cardiac death, MI

or stroke by POD

4) stopped for

futility.

© American College of Cardiology Foundation and American Heart Association, Inc.

Mentzer et al

5,761 CABG

Cariporid

Inhibitor of

Periop MI

Periop MI

Periop MI

Periop MI

Periop MI

Periop

Periop MI

Periop MI 0.003

No difference in mortality

2008

patients at high-

e

sodium

562/2891

19.4%

439/2870

15.3%

0.041

MI 0.213

0.118 to

Cerebrovascular

noted at 6 mo follow-up,

(EXPEDITIO

risk for

hydrogen

6 m

Cerebrovasc

Cerebrovascula

Cerebrovasc

Cerebrovascul

Cerebrov

0.298

Events 0.0001

beneficial effects persisted.

N Study) (7)

perioperative

exchanger

Cerebrovascul

ular Events

r Events

ular Events

ar Events

ascular

Cerebrova

ischemic events at

(isoform 1)

ar Events

3.0% Periop

146/2870

5.2%

0.021

Events

scular

235 centers in 26

limits

86/2839

Death 1.5%

Periop

0.679

Events

countries from

intracellular

Death 2.2%

1.181 to

2001 to 2002

calcium

0.293

(terminated early

overload

due to mortality

from increased

cerebrovascular

events)

MEND-

3,023 intermediate

MC-1

Purinergic

Periop CV

9.00%

Periop CV

9.30%

-0.003

-0.036

"-0.299 to

0.809

CABG II

to high risk CABG

receptor

death or MI

death or MI

0.174"

Investigators

patients at 130

antagonist

133/1,486

140/1,510

2008 (8)

sites in 3 countries

preventing

from 2006 to 2007

cellular calcium

overload

Smith et al.

Discrete and

Pexelizu

Monoclonal

PRIMO II 30

PRIMO II

PRIMO II 30 d

PRIMO II

PRIMO II 30

PRIMO

PRIMO II

PRIMO II 30 d

Combined analysis of

2010

combined analyses

mab

antibody

d death or MI

30 d death

death or MI

30 d death

d death or MI

II 30 d

30 d death

death or MI 0.2

pooled studies stratifying

(PRIMO-

of PRIMO I (3,099

binding to C5

323/2130

or MI

341/2098

or MI

-0.011

death or

or MI

patients by < or ≥2%

CABG I and II

CABG patients at

complement

Combined 30

15.3%

16.3%

MI

-

-0.233 to

expected STS mortality

trials) (9)

205 centers in

aimed at

d mortality

0.072

0.068

noted significant reduction

North American

inhibiting

in 30 d mortality in treated

and Europe from

formation of

pts (5.7 vs. 8.1%; p=0.024)

2002 to 2003) and

the membrane

PRIMO II (4,254

attack complex

CABG patients at

responsible for

249 centers from

cell lysis

2004 to 2005)

ARR indicates absolute risk ratio; CABG, coronary artery bypass graft; CI, confidence interval; CV, cardiovascular; EXPEDITION, Expanding Alzheimer’s Disease Investigators; MC-1, pyridoxal 5’-phosphate; MEND-CABG II, MC- 1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery Trial; MI, myocardial infarction; mPTP, mitochondrial permeability transition pore; NS, nonsignificant; Periop, perioperative; POD, Postoperative Day; PRIMO , Pexelizumab for Reduction of Infarction and Mortality in Coronary Artery Bypass Graft Surgery; RCT, randomized controlled trial; and REDCABG, Reduction in Cardiovascular and Cerebrovascular Events in High-Risk Subjects Undergoing Coronary Artery Bypass Graft Surgery Using Cardiopulmonary Bypass; RR, relative risk; and STS, Society of Thoracic Surgeons.

© American College of Cardiology Foundation and American Heart Association, Inc.

Data Supplement 4. Preconditioning: Table 3 (Comparison of Meta-Analyses of Potential Cardioprotective Effects of Volatile Anesthetics for Patients Undergoing CABG)

Author	Inclusions	No. Studies/	MI; OR; 95% CI; P-Value	Troponin Release; OR; 95% CI; P-Value	Mortality; OR; 95% CI; P-Value
		No. Patients
Symons et al.	HALO, ENF, ISO, SEVO,	27/2979	WMD OR: -3.87; 95% CI: -	OR -1.44 (95% CI: -2.34 to -0.55); p=0.002	OR 0.68 (95% CI: 0.32 to 1.47); p=0.33
2006 (10)	DES; on-/ off-pump		8.75,1.03; p=0.12
Yu et al. 2006	HALO, ENF, ISO, SEVO,	32/2841	OR: 1.34; 95% CI: 0.68 to 2.64;	WMD: (SEVO,DES) OR: -1.45; 95% CI: -1.73 to -1.16;	OR: 0.65; 95%	CI: 0.36 to 1.18; p=0.16
(11)	DES; on-pump		p=0.40	p<0.00001
Landoni et al.	SEVO, DES; on-/off-pump	22/1922	OR: 0.51; 95% CI: 0.32 to 0.84; p for	Not reported	OR: 0.31; 95%	CI: 0.12 to 0.80; p for effect=0.02
2007 (12)			effect=0.008
Yao et al. 2009	SEVO; on-/off-pump	13/696	Not reported	WMD: OR: -0.82; 95% CI: -0.87 to -0.85; p=0.0002	OR: 0.32; 95%	CI: 0.03 to 3.19; p=0.33
(13)

CI indicates confidence interval; DES indicates desflurane; ENF, enflurane; HALO, halothane; ISO, isoflurane; MI, myocardial infarction; OR, odds ratio; SEVO, sevoflurane; and WMD, weighted mean difference.

Data Supplement 5. CABG in Patients With Acute MI

Study Name	Study Type	Patient Population	Findings	Statistical Significance
		Sample Size
Thielmann et al. 2007	Observational	138 STEMI unresponsive to	In-hospital mortality:	p<0.01
(14)	Study	nonsurgical therapy	23.8% when CABG was performed between 7 to 23 h
			6.7% when performed at 1 to 3 d
			4.2% when performed at 4 to 7 d
			2.4% when performed at 8 to 14 d
			Independent predictors of in-hospital death were female gender and preoperative cTnI level
Alexiou et al. 2008 (15)	Observational	220 with ACS; 35 (15.9%) with	In-hospital mortality was 8.5%	p<0.0007
	Study	STEMI	Mean time from onset of symptoms to CABG differed between survivors (5.1±2.7 h) and
			nonsurvivors (11.4±3.2 h)
			Independent predictors of mortality were age >75 y (OR: 5.36; 95% CI: 1.64 to 21.68;
			p=0.028), COPD (OR: 23.04; 95% CI: 4.33 to 158.61; p=0.003), and renal disease (OR: 7.01;
			95% CI: 1.81 to 34.62; p=0.007)
Filizcan et al. 2011 (16)	Observational	150 (114 survived, 36 died)	Overall in-hospital mortality was 22% patients who underwent CABG ≤6 h (6.1%)
	Study		7 to 23 h (50%)
			15 to 30 d (7.1%)
			Predictors of in-hospital mortality were age (OR: 1.049; 95% CI: 1.013 to 1.087; p=0.008),
			preoperative IABP (OR: 4.386; 95% CI: 1.381 to 13.933; p=0.012), and preoperative cTnl
			(OR: 1.019; 95% CI: 1.002 to 1.036; p=0.027).
© American College of Cardiology Foundation and American Heart Association, Inc.