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J Thorac Cardiovasc Surg 2003;126:1071-1075
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Association of lipoprotein(a) excess with early vein graft occlusions in middle-aged men undergoing coronary artery bypass surgery

Sergei N. Pokrovsky, PhDa,*, Marat V. Ezhov, MDa, Larisa N. Il'ina, MDa, Olga I. Afanasieva, PhDa, Valentin Y. Sinitsyn, MDa, Andrey A. Shiriaev, MDa, Renat S. Akchurin, MDa

a Cardiology Research Center, Moscow, Russia

Received for publication May 31, 2002; revisions received September 24, 2002; revisions received October 8, 2002; accepted for publication October 22, 2002.

* Address for reprints: Sergei N. Pokrovsky, PhD, Cardiology Research Center, 15a, 3rd Cherepkovskaya Street, Moscow 121552, Russia
dr.pokrovsky{at}cardio.ru

OBJECTIVE: To assess the relationship of lipoprotein(a) to early vein graft occlusions in patients after coronary artery bypass grafting.

METHODS: We studied 102 male patients (mean age 52.3 ± 8.6 years) with chest pain occurrence during the first year (mean time 5.3 ± 3.0 months) after surgical myocardial revascularization. Graft patency was examined by electron-beam computed tomography (n = 102) and quantitative coronary angiography (n = 31).

RESULTS: Patients were divided into 2 groups according to graft patency data: 66 (65%) with occlusions and 36 (35%) without occlusions at follow-up. No significant differences were found between the groups concerning age, smoking, family history of coronary heart disease, previous myocardial infarction, hypertension, serum lipids, and apolipoprotein B. Lipoprotein(a) level was significantly higher in patients with occluded grafts with a median (95% confidence intervals) of 24 mg/dL (17-42 mg/dL) versus 12 mg/dL (6-24 mg/dL) in patients with patent grafts, P < .01. More patients with nonoccluded grafts were taking statins postoperatively: 42% versus 18% of patients with occluded grafts, P < .05. The sensitivity and specificity of electron-beam computed tomography in revealing vein graft occlusion was close to 100%.

CONCLUSION: There is an association between high lipoprotein(a) level and vein graft occlusions in middle-aged men during the first year after coronary artery bypass grafting. Use of statins is associated with a lower rate of vein graft occlusion. Electron-beam tomography could be useful for assessing graft occlusions.






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