Impact of High Lipoprotein(a) on Long‐Term Survival Following Coronary Artery Bypass Grafting

Abstract

Background Lipoprotein(a) is a possible causal risk factor for atherosclerosis and related complications. The distribution and prognostic implication of lipoprotein(a) in patients undergoing coronary artery bypass grafting remain unknown. This study aimed to assess the impact of high lipoprotein(a) on the long‐term prognosis of patients undergoing coronary artery bypass grafting. Methods and Results Consecutive patients with stable coronary artery disease who underwent isolated coronary artery bypass grafting from January 2013 to December 2018 from a single‐center cohort were included. The primary outcome was all‐cause death. The secondary outcome was a composite of major adverse cardiovascular and cerebrovascular events. Of the 18 544 patients, 4072 (22.0%) were identified as the high‐lipoprotein(a) group (≥50 mg/dL). During a median follow‐up of 3.2 years, primary outcomes occurred in 587 patients. High lipoprotein(a) was associated with increased risk of all‐cause death (high lipoprotein(a) versus low lipoprotein(a): adjusted hazard ratio [aHR], 1.31 [95% CI, 1.09–1.59]; P =0.005; lipoprotein(a) per 1‐mg/dL increase: aHR, 1.003 [95% CI, 1.001–1.006]; P =0.011) and major adverse cardiovascular and cerebrovascular events (high lipoprotein(a) versus low lipoprotein(a): aHR, 1.18 [95% CI, 1.06–1.33]; P =0.004; lipoprotein(a) per 1‐mg/dL increase: aHR, 1.002 [95% CI, 1.001–1.004]; P =0.002). The lipoprotein(a)‐related risk was greater in patients with European System for Cardiac Operative Risk Evaluation <3, and tended to attenuate in patients receiving arterial grafts. Conclusions More than 1 in 5 patients with stable coronary artery disease who underwent coronary artery bypass grafting were exposed to high lipoprotein(a), which is associated with higher risks of death and major adverse cardiovascular and cerebrovascular events. The adverse effects of lipoprotein(a) were more pronounced in patients with clinically low‐risk profiles or not receiving arterial grafts.

Dynamics of the State of the Arterial Stiffness as a Possible Pathophysiological Factor of Unfavorable Long-Term Prognosis in Patients after Coronary Artery Bypass Grafting

“…Long-term prognosis in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG) depends not only on preoperative factors (initial severity of coronary disease and myocardial condition, comorbidity, level of pathological biomarkers) [1][2][3], but also from further treatment and rehabilitation measures. The task of secondary prevention in this category of patients Disclaimer/Publisher's Note: The statements, opinions, and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s).…”

“…Not surprisingly, most studies have focused on identifying baseline factors associated with long-term prognosis after CABG. For example, recent studies have shown the prognostic impact of biomarkers such as lipoprotein (a) [3] and LDL/HDL ratio [2] during 10-year follow-up of patients after CABG. The presence of a large number of risk factors and biomarkers that need to be adjusted and monitored when managing this category of patients creates certain inconvenience for practitioners and can lead to excessive expenditure of resources.…”

Dynamics of the State of Arterial Stiffness as a Possible Pathophysiological Factor of Unfavorable Long-Term Prognosis in Patients after Coronary Artery Bypass Grafting

“…Long-term prognosis in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG) depends not only on preoperative factors (initial severity of coronary disease and myocardial condition, comorbidity, level of pathological biomarkers) [1][2][3], but also from further treatment and rehabilitation measures. The task of secondary prevention in this category of patients is to level out those unfavorable risk factors that led to the CAD development, and, ultimately, to the need for myocardial revascularization [4,5].…”

“…Not surprisingly, most studies have focused on identifying baseline factors associated with long-term prognosis after CABG. For example, recent studies have shown the prognostic impact of biomarkers such as lipoprotein (a) [3] and LDL/HDL ratio [2] during 10-year follow-up of patients after CABG. The presence of a large number of risk factors and biomarkers that need to be adjusted and monitored when managing this category of patients creates a certain inconvenience for practitioners and can lead to excessive expenditure of resources.…”