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Cascade plasma filtration during the first year after CABG in patients with hyperlipidemia refractory to statins

Marat V Ezhov1, Larisa N Il'ina, Maya S Safarova

  • 1Cardiology Research Center, 15a, 3rd Cherepkovskaya Street, 121552 Moscow, Russia.

Atherosclerosis. Supplements
|January 30, 2013
PubMed

Insights

Weekly lipid apheresis significantly improved vein graft patency after coronary artery bypass grafting (CABG) in patients with statin-resistant hyperlipidemia. This treatment reduced graft occlusions, suggesting a benefit for long-term cardiovascular health.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Lipidology

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
  • Graft patency is crucial for long-term outcomes after CABG.
  • Hyperlipidemia refractory to statins poses a significant risk for graft failure and cardiovascular events.

Purpose of the Study:

  • To assess the efficacy of weekly lipid apheresis in maintaining vein graft patency post-CABG.
  • To evaluate the impact of apheresis on lipid profiles in patients with statin-refractory hyperlipidemia.
  • To determine the effect of apheresis on graft occlusion rates within the first year after CABG.

Main Methods:

  • A 12-month prospective controlled clinical trial involving 34 male patients undergoing CABG with LDL-C >2.6 mmol/L despite statin therapy.
  • Patients were randomized into two groups: weekly cascade plasma filtration (CPF) apheresis plus atorvastatin (active group, n=17) or atorvastatin alone (control group, n=17).
  • Vein graft patency was assessed using multislice computed tomography at 3 months and angiography at 12 months post-operation.

Main Results:

  • Weekly apheresis with CPF significantly reduced LDL-C by 64%, apoB by 65%, and Lp(a) by 52% compared to baseline and the control group.
  • Vein graft patency at 12 months was 88.2% in the apheresis group versus 72.7% in the control group (p=0.05).
  • Lipid apheresis was associated with a 46% reduction in vein graft occlusions (relative risk 0.54, p=0.05).

Conclusions:

  • Weekly lipoprotein apheresis using CPF improves vein graft patency in the first year after CABG.
  • This apheresis strategy is effective in managing hyperlipidemia refractory to statin therapy in post-CABG patients.
  • Lipid apheresis demonstrates potential to reduce graft occlusion and enhance long-term outcomes following CABG.
Abstract

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