Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland.
Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-529 Poznań, Poland.
Medicina (Kaunas). 2021 Aug 26;57(9):875. doi: 10.3390/medicina57090875.
: Coronary artery disease is still a major cause of death in developed countries. Low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy is a key strategy in major acute coronary events' prevention. The aim of the study was to establish if there is a cardioprotective effect of pre-operative LDL lowering therapy on perioperative myocaridal injury in patients undergoing off-pump coronary artery bypass grafting (CABG). Moreover, the impact of pre-operative LDL level on long term outcome was analysed. : The retrospective single center analysis included 662 consecutive patients (431 (65%) males and 231 (35%) female, mean age of 65 ± 8) referred for cardiac surgery due to stable chronic coronary syndrome between 2012-2018. The follow up was 9 years. : A statistically significant difference was found in postoperative serum Troponin-I for LDL thresholds of 1.8 mmol/L ( = 0.009), 2.6 mmol/L ( = 0.03) and 3.0 mmol/L ( = 0.001). The results indicate that cardioprotective role of LDL is achieved within LDL concentration rate below 1.8 mmol/L (<70 mg/dL). Five patients died perioperatively, whereas 1-year and 9-year overall mortality rates were 4% ( = 28) and 18.6% ( = 123), respectively. Comparing the survival group with diseased, Mann-Whitney U test showed a statistically significant difference in HDL-C ( = 0.007), Troponin ( = 0.009), Castelli index ( = 0.001) and atherogenic index ( = 0.004). Preoperative levels of total cholesterol, LDL-C and HDL-C did not significantly differ between survivors and diseased. The 9-year mortality risk did not differ significantly between subgroups divided according to LDL-C thresholds of 1.4 mmol/L (55 mg/dL), 1.8 mmol/L (70 mg/dL), 2.6 mmol/L (100 mg/dL) and 3.0 mmol/L (116 mg/dL). Preoperative low level of LDL-C cholesterol (below 1.83 mmol/L, 70 mg/dL) has a cardioprotective effect on perioperative myocardial injury in off-pump coronary artery bypass grafting.
: 在发达国家，冠心病仍然是主要死亡原因。他汀类药物治疗降低低密度脂蛋白胆固醇（LDL-C）是预防主要急性冠状动脉事件的关键策略。本研究旨在确定在非体外循环冠状动脉旁路移植术（CABG）中，术前 LDL 降低治疗对围手术期心肌损伤是否具有心脏保护作用。此外，还分析了术前 LDL 水平对长期结果的影响。: 该回顾性单中心分析纳入了 2012 年至 2018 年间因稳定型慢性冠状动脉综合征接受心脏手术的 662 例连续患者（431 例（65%）男性和 231 例（35%）女性，平均年龄 65±8 岁）。随访 9 年。: 对于 LDL 阈值为 1.8 mmol/L（=0.009）、2.6 mmol/L（=0.03）和 3.0 mmol/L（=0.001），术后血清肌钙蛋白 I 存在统计学显著差异。结果表明，LDL 浓度低于 1.8mmol/L（<70mg/dL）时，LDL 具有心脏保护作用。5 例患者围手术期死亡，1 年和 9 年总死亡率分别为 4%（=28）和 18.6%（=123）。与患病患者比较，Mann-Whitney U 检验显示 HDL-C（=0.007）、肌钙蛋白（=0.009）、Castelli 指数（=0.001）和致动脉粥样硬化指数（=0.004）存在统计学显著差异。幸存者和患病者之间总胆固醇、LDL-C 和 HDL-C 的术前水平无显著差异。根据 LDL-C 阈值 1.4mmol/L（55mg/dL）、1.8mmol/L（70mg/dL）、2.6mmol/L（100mg/dL）和 3.0mmol/L（116mg/dL）分为亚组，9 年死亡率无显著差异。术前 LDL-C 胆固醇水平较低（低于 1.83mmol/L，70mg/dL）对非体外循环冠状动脉旁路移植术围手术期心肌损伤具有心脏保护作用。
