Yu Qixiang, Xue Qing, Liu Hao, Hu Junlong, Wang Rui, Song Yuanyuan, Zhou Yanzai, Zhang Wei, Zhu Yunpeng, Zhao Qiang
Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China.
Front Cardiovasc Med. 2023 Mar 24;10:1103681. doi: 10.3389/fcvm.2023.1103681. eCollection 2023.
The objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).
This is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8-<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2-6.1) years.
During the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8-<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8-<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12-3.29; = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29-6.64; < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06-2.18; = 0.022).
For CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.
本研究旨在评估低密度脂蛋白胆固醇（LDL-C）和脂蛋白(a) [Lp(a)] 对接受冠状动脉旁路移植术（CABG）患者临床结局的影响。
这是对DACAB试验（NCT02201771）进行5年随访的二次分析，该试验中500例接受初次单纯CABG的患者术后随机接受为期1年的三联抗血小板治疗。其中，459例患者纳入本次二次分析。收集基线LDL-C和Lp(a)水平，并记录随访期间LDL-C水平的重复测量值。LDL-C的临界值设定为1.8和2.6 mmol/L；因此，患者被分为LDL-C<1.8、1.8-<2.6和≥2.6 mmol/L亚组。Lp(a)的临界值为30 mg/dL；因此，患者被分为Lp(a)<30和≥30 mg/dL亚组。主要结局为4点主要不良心血管事件（MACE-4），即全因死亡、心肌梗死、中风和再次血运重建的复合事件。中位随访时间为5.2（四分位间距，4.2-6.1）年。
随访期间，129例（28.1%）患者LDL-C<1.8 mmol/L，186例（40.5%）患者LDL-C为1.8-<2.6 mmol/L，144例（31.4%）患者LDL-C≥2.6 mmol/L。与术后LDL-C<1.8 mmol/L组相比，LDL-C为1.8-<2.6 mmol/L组发生MACE-4的风险显著更高[校正风险比（aHR）=1.92，95%CI，1.12-3.29；P=0.019]，LDL-C≥2.6 mmol/L组也是如此（aHR=3.90，95%CI，2.29-6.64；P<0.001）。131例（28.5%）患者基线Lp(a)≥30 mg/dL，其发生MACE-4的风险增加（aHR=1.52，95%CI，1.06-2.18；P=0.022）。
对于CABG患者，术后LDL-C水平升高或基线Lp(a)升高与较差的中期临床结局相关。我们的研究结果表明，在CABG人群中实现LDL-C目标的必要性以及添加针对Lp(a)的降脂治疗的潜在益处。
