Kulik Alexander, Abreu Amy M, Boronat Viviana, Ruel Marc
Division of Cardiac Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, Florida, USA.
Division of Cardiac Surgery, The University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
J Card Surg. 2020 Dec;35(12):3286-3293. doi: 10.1111/jocs.15014. Epub 2020 Oct 6.
High-dose atorvastatin did not improve 1-year vein graft patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial. However, it remains unknown whether high-intensity statins may impact graft disease in the years that follow.
In the trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80 mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the choice of statin was left to the patient's physician. In this study of participants who agreed to follow-up (N = 76), low-density lipoprotein (LDL) levels were measured and graft patency was assessed 3 years after surgery.
The rate of vein graft disease 3 years after surgery was not significantly reduced with atorvastatin 80 mg during the first postoperative year or the use of open-label high-intensity statin thereafter (p = NS). However, a trend was observed between higher LDL levels during the first postoperative year and a greater incidence of vein graft disease at 3 years (p = .12). Among patients who had LDL levels more than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl (p = .15). Higher mean LDL levels during the first postoperative year were associated with a higher rate of vein disease 3 years after surgery both at the graft level (p = .03) and at the patient level (p = .03) in multivariate analysis.
Higher LDL levels during the first postoperative year were associated with significantly greater vein graft disease 3 years after CABG.
在近期的“积极胆固醇治疗以抑制静脉移植物事件”试验中，大剂量阿托伐他汀未能改善静脉移植物的1年通畅率。然而，高强度他汀类药物在随后几年是否会影响移植物疾病仍不清楚。
在该试验中，患者（N = 173）在冠状动脉搭桥手术（CABG）后被随机分配接受10或80毫克阿托伐他汀治疗1年。1年后，他汀类药物的选择由患者的医生决定。在这项对同意随访的参与者（N = 76）的研究中，测量了低密度脂蛋白（LDL）水平，并在术后3年评估了移植物通畅率。
术后第1年使用80毫克阿托伐他汀或此后使用开放标签的高强度他汀类药物，术后3年静脉移植物疾病的发生率并未显著降低（p = 无显著性差异）。然而，观察到术后第1年较高的LDL水平与3年时静脉移植物疾病的发生率较高之间存在一种趋势（p = 0.12）。在CABG后第1年LDL水平超过90毫克/分升的患者中，38.5%在3年时有静脉移植物疾病，而LDL水平低于90毫克/分升的患者中这一比例为19.0%（p = 0.15）。在多变量分析中，术后第1年较高的平均LDL水平与术后3年静脉疾病的发生率较高在移植物水平（p = 0.03）和患者水平（p = 0.03）均相关。
术后第1年较高的LDL水平与CABG后3年时显著更严重的静脉移植物疾病相关。
