AUTHOR=Yu Qixiang , Xue Qing , Liu Hao , Hu Junlong , Wang Rui , Song Yuanyuan , Zhou Yanzai , Zhang Wei , Zhu Yunpeng , Zhao Qiang 

TITLE=Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: A secondary analysis of the DACAB trial

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1103681

DOI=10.3389/fcvm.2023.1103681

ISSN=2297-055X

ABSTRACT=Abstract
Purpose: The objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).
Methods: This is a secondary analysis of 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three antiplatelet therapy for one year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L, thus the patients were stratified into LDL-C <1.8, 1.8- <2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL, thus the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2-6.1) years.
Results: During the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8- <2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in LDL-C 1.8- <2.6 mmol/L group (adjusted hazard ratio [aHR] = 1.92, 95% CI, 1.12-3.29; P = 0.019) and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29-6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06-2.18; P = 0.022).
Conclusions: For CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.