These patients constitute a higher-risk groupbecausetheyhavealreadyundergoneCABG,typicallyfor more extensive CAD, and they have more comorbidities.620 624 In the PURSUIT trial, 12%1,134 of the patients had prior CABG and more adverse follow-up outcomes, including increased mortality, but had a benefit with eptifibatide similar to those without prior CABG.622 Patients with prior CABG are less likely to undergo early catheterization after NSTEMI. In the Get With The Guidelines study of patients with NSTEMI, 18.5% had prior CABG and a lower likelihood of early inva- sive evaluation but had higher rates of guideline-recommended clopidogrel and bivalirudin therapy and lower rates of GP IIb/ IIIa and anticoagulant therapy.625 In patients with prior CABG who develop NSTE-ACS that is related to an ungrafted native coronary vessel, treatment should follow GDMT.26 Because patients with prior CABG presenting with ACS are a high-risk group with increased comorbid characteris- tics and high-risk anatomy, a strategy of early angiography should be implemented (unless clinically contraindicated), and these patients should receive optimal antiplatelet and anticoagulant therapy. See Online Data Supplement 28 for additional information on post-CABG. 7.5. Perioperative NSTE-ACS Related to Noncardiac Surgery: Recommendations Class I 1. Patients who develop NSTE-ACS following noncar- diac surgery should receive GDMT as recommended for patients in the general population but with the modifications imposed by the specific noncardiac surgical procedure and the severity of the NSTE- (Level of Evidence: C) 2. 