Previous MI and LV Dysfunction Recommendations

1. In the absence of contraindications, β-blockers (bisoprolol, carvedilol, and sustained-release metoprolol succinate) are recommended after CABG to all patients with reduced EF (<40%), especially among patients with heart failure or those with prior MI (Class I; Level of Evidence A).
2. In the absence of contraindications, ACE inhibitor or ARB therapy (if the patient is ACE inhibitor intolerant) is recommended after CABG to all patients with LV dysfunction (EF <40%) or previous MI (Class I; Level of Evidence B).
3. In the absence of contraindications, it is reasonable to add an aldosterone antagonist (on top of β-blocker and ACE inhibitor therapy) after CABG for patients with LV dysfunction (EF <35%) who have class NYHA class II to IV heart failure symptoms (Class IIa; Level of Evidence B).
4. Among patients with LV dysfunction (EF <35%), ICD therapy is not recommended for the prevention of sudden cardiac death after CABG until 3 months of postoperative goal-directed medical therapy has been provided and persistent LV dysfunction has been confirmed (Class III; Level of Evidence A).