Korpilahti K, Engblom E, Syvänne M, Hämäläinen H, Puukka P, Vänttinen E, Rönnemaa T
Department of Medicine, Turku University Hospital, Finland.
Scand Cardiovasc J. 1998;32(6):343-51. doi: 10.1080/14017439850139799.
The association between cardiovascular risk factors and stenosis or occlusion of saphenous vein grafts was analysed in a prospective 5-year study of 176 unselected patients with coronary artery bypass grafting (CABG). Methods included serial measurements of serum lipids and lipoproteins, determination of apolipoprotein E phenotype, lipoprotein (a) levels 5 years postoperatively, and subcutaneous fat biopsy to determine the fatty acid composition before and one year after CABG. Graft angiography with quantitative analysis of angiograms was performed at the end of follow-up. A coronary artery with diameter < or = 1.5 mm was associated with occlusion of vein grafts (p < 0.01). The mean levels of serum lipids and lipoproteins, other traditional risk factors for atherosclerosis, and subcutaneous fatty acid composition were similar in patients with and without graft occlusion, and similar when the maximum diameter of non-occluded grafts was < 50% vs > or = 50%, and < 25% vs > or = 25%. High lipoprotein (a) concentration tended to be associated with obstructive changes in vein grafts. Our data indicate that, because lipids, lipoproteins and other traditional cardiovascular risk factors do not predict occlusion or stenosis of saphenous vein grafts five years after CABG, it is not currently possible to predict directly from the levels of these risk factors which patients are likely to benefit from pharmacological or other interventions.
在一项针对176例未经选择的接受冠状动脉旁路移植术（CABG）患者的前瞻性5年研究中，分析了心血管危险因素与隐静脉移植血管狭窄或闭塞之间的关联。方法包括连续测量血脂和脂蛋白、测定载脂蛋白E表型、术后5年的脂蛋白（a）水平，以及在CABG术前和术后1年进行皮下脂肪活检以确定脂肪酸组成。在随访结束时进行移植血管造影并对血管造影进行定量分析。直径≤1.5 mm的冠状动脉与静脉移植血管闭塞相关（p<0.01）。有或没有移植血管闭塞的患者，其血脂和脂蛋白的平均水平、动脉粥样硬化的其他传统危险因素以及皮下脂肪酸组成相似，并且当未闭塞移植血管的最大直径<50%与≥50%，以及<25%与≥25%时也相似。高脂蛋白（a）浓度往往与静脉移植血管的阻塞性改变相关。我们的数据表明，由于血脂、脂蛋白和其他传统心血管危险因素不能预测CABG术后5年隐静脉移植血管的闭塞或狭窄，目前无法直接根据这些危险因素的水平预测哪些患者可能从药物或其他干预措施中获益。
