Impact of lipid levels and high‐intensity statins on vein graft patency after CABG: Midterm results of the ACTIVE trial

Autor:	Amy M. Abreu, Alexander Kulik, Viviana Boronat, Marc Ruel
Rok vydání:	2020
Předmět:	Pulmonary and Respiratory Medicine medicine.medical_specialty Statin medicine.drug_class Atorvastatin 030204 cardiovascular system & hematology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine Humans Saphenous Vein Coronary Artery Bypass Vein Vascular Patency Cholesterol business.industry Incidence (epidemiology) Graft Occlusion Vascular Surgery Treatment Outcome medicine.anatomical_structure 030228 respiratory system Bypass surgery chemistry lipids (amino acids peptides and proteins) Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine Vein graft disease business Lipoprotein medicine.drug
Zdroj:	Journal of Cardiac Surgery. 35:3286-3293
ISSN:	1540-8191 0886-0440
DOI:	10.1111/jocs.15014
Popis:	BACKGROUND High-dose atorvastatin did not improve 1-year vein graft patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial. However, it remains unknown whether high-intensity statins may impact graft disease in the years that follow. METHODS In the trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80 mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the choice of statin was left to the patient's physician. In this study of participants who agreed to follow-up (N = 76), low-density lipoprotein (LDL) levels were measured and graft patency was assessed 3 years after surgery. RESULTS The rate of vein graft disease 3 years after surgery was not significantly reduced with atorvastatin 80 mg during the first postoperative year or the use of open-label high-intensity statin thereafter (p = NS). However, a trend was observed between higher LDL levels during the first postoperative year and a greater incidence of vein graft disease at 3 years (p = .12). Among patients who had LDL levels more than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl (p = .15). Higher mean LDL levels during the first postoperative year were associated with a higher rate of vein disease 3 years after surgery both at the graft level (p = .03) and at the patient level (p = .03) in multivariate analysis. CONCLUSIONS Higher LDL levels during the first postoperative year were associated with significantly greater vein graft disease 3 years after CABG.
Databáze:	OpenAIRE
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