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The predictive value of lipid studies in patients undergoing cardiac catheterization and open heart surgery
Insights
A one-time lipid profile, including lipoproteins, is not a reliable predictor of coronary artery disease severity or need for bypass surgery. These tests lack diagnostic significance for assessing coronary artery disease in a single determination.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Diagnostic Biomarkers
Background:
- Lipid profiles are routinely ordered for patients undergoing cardiac catheterization.
- These profiles include measurements of high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, and apolipoproteins A-I and B.
- The diagnostic utility of a single lipid profile determination as a predictor of coronary artery disease (CAD) remains to be fully elucidated.
Purpose of the Study:
- To evaluate the diagnostic significance and sensitivity of a one-time lipid profile measurement.
- To assess the predictive value of lipid and apolipoprotein levels for coronary artery disease.
- To determine if lipid profiles correlate with the severity of coronary artery disease as measured by percent occlusion.
Main Methods:
- Retrospective analysis of lipid profiles from 311 patients (247 with CAD, 34 with valvular stenosis, 30 controls).
- Patients underwent cardiac catheterization prior to potential coronary bypass surgery.
- Lipid profiles included high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, and apolipoproteins A-I and B.
- Coronary artery disease severity was quantified by percent occlusion from surgical results.
Main Results:
- No significant correlations were found between lipoprotein levels and the degree of coronary artery occlusion in patients with CAD.
- Calculations of sensitivity and specificity for various lipid values indicated limited clinical utility for a single determination.
- The prevalence of CAD in the study population was 77%.
Conclusions:
- A single, one-time determination of standard lipid and apolipoprotein values has no demonstrated clinical use in predicting coronary artery disease or its severity.
- Routine lipid profiles performed pre-catheterization are not effective diagnostic tools for assessing the extent of coronary artery disease.
- Further research may be needed to explore the role of serial lipid measurements or other biomarkers in CAD assessment.
Abstract:
All patients admitted for cardiac catheterization prior to possible coronary bypass surgery have a lipid profile ordered as part of their preadmission laboratory work. These studies, usually the first and only performed on the patient, include: high and low density lipoprotein-cholesterol, total cholesterol, triglyceride, and apolipoproteins A-I and B. This study was designed to determine the diagnostic significance and sensitivity of these tests based on a one-time determination as predictors of coronary artery disease. The three groups studied included those patients with surgically confirmed coronary artery disease (n = 247), aortic and/or mitral stenosis (n = 34), and normals, those free of disease (n = 30). The total population was 311 subjects, ranging in age from 20-85 years, which comprised 250 males and 61 postmenopausal females. The prevalence of the disease was 77% over the total population, with 238 of those with coronary artery disease going on to bypass surgery. Surgical results of cardiac catheterization were collected as percent occlusion. No correlations were found between lipoproteins and percent occlusion in the diseased group. Calculations of sensitivity and specificity for various lipid values suggested no clinical use for a one-time determination of these apo- and lipoproteins.