In the absence of severe, symptomatic aorto-iliac occlusive disease or PAD, the insertion of an in- traaortic balloon is reasonable to reduce mortality rate in CABG patients who are considered to be at high risk (eg, those who are undergoing reoperation or have LVEF <30% or left main CAD).1021 1026 (Level of Evidence: B) 2. Measurement of biomarkers of myonecrosis (eg, creatine kinase-MB, troponin) is reasonable in the first 24 hours after CABG.200 (Level of Evidence: B) Intraaortic balloon counterpulsation is an established me- chanical cardiac support procedure that has been demon- strated to increase cardiac output and to improve coronary blood flow.1025,1026 In several RCTs, its preoperative initiation and perioperative use have been shown to reduce the mortal- ity rate in CABG patients who are considered to be at high risk (ie, those undergoing repeat CABG, those with an LVEF 30%, or those with left main CAD)1022 1024 despite its known associated vascular complications.1021 In contrast, its routine use in subjects who are not thought to be high risk has not been demonstrated.1027 Some myocyte necrosis often occurs during and immedi- ately after CABG, caused by cardiac manipulation, inade- quate myocardial protection, intraoperative defibrillation, or acute graft failure. A determination of the frequency and magnitude with which postoperative myonecrosis occurs has been difficult. 