The Effects of Lipid-Lowering Therapy on Graft Patency in Coronary Bypass Surgery Patients

Authors

  • Mutasim Sungun
  • Melih Hulusi Us
  • Rifat Eralp Ulusoy
  • Ozcan Keskin
  • Sibel Pocan
  • Kaan Inan
  • Ahmet Turan Yilmaz

DOI:

https://doi.org/10.1532/HSF98.20051158

Abstract

Background. Our aim was to investigate the effects of lipid-lowering treatment (LLT) on graft patency in coronary artery bypass grafting (CABG) patients.

Methods. A total of 209 CABG patients (95 men, 45%) with a total cholesterol level above 200 mg/dL and a low-density lipoprotein level above 100 mg/dL were included. Patients were divided into 2 groups on the basis of administration of LLT after CABG: group 1 received LLT after the operation (those patients undergoing operations after 1998, n = 102, 49% male) and group 2 did not receive LLT after the operation (those patients undergoing operations between 1992 and 1998, n = 107, 42% male). Median duration of follow-up was 5.2 years. Follow-up angiography could be obtained in 108 (52%) patients (56 in group 1, 52 in group 2).

Results. There was a 42% reduction in ischemic events and deaths in group 1, and 60% of these patients had a symptom-free or event-free period for 6 years. The 5-year graft patency for left internal mammary artery-to-left anterior descending artery grafts in group 1 was 95%, and the corresponding figure was 90% in group 2. Right coronary artery-to-saphenous vein graft patency was 66% for group 1 and 30% for group 2. Circumflex artery-to-saphenous vein patency rate was 59% for group 1 and 53% for group 2. A higher graft patency was found in group 1 as a whole.

Conclusion. Results of this retrospective study support the fact that LLT provides a higher graft patency for CABG patients.

References

American Heart Association. 2003. Statistical fact sheet populations. International Disease Statistics. Dallas, Tex: American Heart Association.nAzen SP, Mack WJ, Cashin-Hemphill L, et al. 1996. Progression of coronary artery disease predicts clinical coronary events. Long-term follow-up from the Cholesterol Lowering Atherosclerosis Study. Circulation 93:34-41.nBlankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. 1987. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA 257:3233-40.nBrown G, Albers JJ, Fisher LD, et al. 1990. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 323:1289-98.nCashin-Hemphill L, Mack WJ, Pogoda JM, Sanmarco ME, Azen SP, Blankenhorn DH. 1990. Beneficial effects of colestipol-niacin therapy on coronary atherosclerosis. A 4-year follow-up. JAMA 264:3013-7.nCrouse JR 3rd, Byington RP, Bond MG, et al. 1995. Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II). Am J Cardiol 75:455-9.nFrick MH, Syvanne M, Nieminen NS, et al. 1997. Prevention of the angiographic progression of coronary and vein-graft atherosclerosis by gemfibrozil after coronary bypass surgery in men with low levels of HDL cholesterol. Lopid Coronary Angiography Trial (LOCAT) Study Group. Circulation 96:2137-43.nFriedewald WT, Levy RI, Fredrickson DS. 1972. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499-502.nHaim M, Benderly M, Brunner D, et al. 1999. Elevated serum triglyceride levels and long-term mortality in patients with coronary heart disease: the Bezafibrate Infarction Prevention Registry. Circulation 100:475-82.nHeart Protection Study Collaborative Group. 2002. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360:7-22.nHuttunen J, Manninen V, Manttari M, et al. 1991. The Helsinki Heart Study: central findings and clinical implications. Ann Med. 23:155-9.nJukema JW, Bruschke AVG, Boven JV, et al. 1995. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS). Circulation 91:2528-40.nLewis SJ, Moye LA, Sacks FM, et al. 1998. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 129:681-9.nThe Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. 1998. Prevention of cardiovascular events and death in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 339:1349-157.nThe Post Coronary Artery Bypass Graft (PCABG) Trial Investigators. 1997. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary artery bypass grafts. N Engl J Med 336:153-62.nPedersen TR, Kjekshus J, Faergeman O, et al. 1998. Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S). Circulation 97:1453-60.nPitt B, Ellis SG, Mancini GB, Rosman HS, McGovern ME. 1993. Design and recruitment in the United States of a multicenter quantitative angiographic trial of pravastatin to limit atherosclerosis in the coronary arteries (PLAC I). Am J Cardiol 72:31-5.nPitt B, Mancini GB, Ellis SG, Rosman HS, Park JS, McGovern ME. 1995. Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC 1): reduction in atherosclerosis progression and clinical events. PLAC 1 investigation. J Am Coll Cardiol 26:1133-9.nRavnskov U. 1992. Cholesterol-lowering trials in coronary heart disease: frequency of citation and outcome. BMJ 305:15-9.nRubins HB, Robins SJ, Collins D, et al. 1999. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 341:410-8.nSacks FM, Moye LA, Davis BR, et al. 1998. Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events Trial. Circulation 97:1446-52.nScandinavian Simvastatin Survival Study Group. 1994. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344:1383-9.nSever PS, Dahlof P, Poulter NR, et al. 2003. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower than average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361:1149-58.nShepherd J, Blauw GJ, Murphy MB, et al. 2002. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 360:1623-30.nShepherd J, Cobbe SM, Ford I, et al. 1995. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Group (WOSCOPS). N Engl J Med 333:1301-7.nWHO. 1980. Cooperative trial on primary prevention of ischemic heart disease using clofibrate to lower serum cholesterol: mortality follow-up. Report of the Committee of Principal Investigators. Lancet 2:379-85.nWHO, The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva: World Health Organization.nWest of Scotland Coronary Prevention Study (WOSCOPS) Group. 1998. Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study. Circulation 97:1440-5.n

Published

2006-05-02

How to Cite

Sungun, M., Us, M. H., Ulusoy, R. E., Keskin, O., Pocan, S., Inan, K., & Yilmaz, A. T. (2006). The Effects of Lipid-Lowering Therapy on Graft Patency in Coronary Bypass Surgery Patients. The Heart Surgery Forum, 9(3), E626-E629. https://doi.org/10.1532/HSF98.20051158

Issue

Section

Articles

Most read articles by the same author(s)