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Impact of Conventional Cardiovascular Risk Factors on Left Internal Mammary Artery Graft Disease
Hui-Juan Zuo1, Nan Nan2, Hong-Xia Yang2
1Department of Community Health Research, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China.
Insights
Postoperative smoking and hyperglycemia without diabetes increase the risk of left internal mammary artery (LIMA) graft stenosis after coronary artery bypass grafting (CABG). Statin use and low LDL-C levels reduce this risk.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Atherosclerosis Research
Background:
- Atherosclerosis is a primary cause of coronary artery graft stenosis.
- Left internal mammary artery (LIMA) is the preferred graft for coronary artery bypass grafting (CABG).
- Understanding risk factors for LIMA graft stenosis is crucial for long-term graft patency.
Purpose of the Study:
- To evaluate the impact of conventional cardiovascular risk factors on LIMA graft stenosis.
- To identify predictors of LIMA graft stenosis in patients who underwent CABG.
Main Methods:
- Retrospective study of 618 patients hospitalized for coronary angiography post-CABG (2010-2017).
- Inclusion criteria: recurrence of chest pain, age ≥18, confirmed LIMA graft.
- Multivariate analysis to assess the relationship between risk factors and LIMA graft stenosis.
Main Results:
- LIMA graft stenosis observed in 26.1% of participants.
- Postoperative smoking, longer CABG duration (≥10 years), and hyperglycemia without diabetes were associated with increased LIMA graft stenosis risk.
- Statin use and low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L significantly reduced the risk of LIMA graft stenosis.
Conclusions:
- Postoperative smoking and hyperglycemia in non-diabetic patients are significant risk factors for LIMA graft stenosis.
- Statin therapy and achieving LDL-C levels below 1.8 mmol/L are protective against LIMA graft stenosis.
Background:
The development of atherosclerosis was considered as the common cause of the stenosis of coronary artery grafts. Left internal mammary artery (LIMA) was the best artery graft for further effectiveness of coronary artery bypass grafting (CABG). We sought to assess the impact of known conventional cardiovascular risk factors (RFs) on LIMA graft stenosis.
Methods:
A retrospective study including 618 participants, who had recurrence of chest pain after CABG, aged ≥18 years, hospitalized for coronary angiography in Beijing Anzhen hospital between 2010 and 2017 was performed. All the participants were confirmed to have LIMA graft. Multivariate analysis was conducted to determine the relationship between conventional RFs and LIMA graft stenosis.
Results:
Of the study, 220 (35.6%) participants continued to smoke, 504 (81.6%) were overweight or obese, and 411 (66.5%) and 242 (39.2%) reported concomitant hypertension and diabetes, respectively. LIMA graft stenosis occurred in 161 participants (26.1%). Postoperative smoking, a CABG duration of ≥10 years and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis, the odds ratio (OR) was 1.86 [95% confidence interval (CI): 1.26-2.78], 2.24 (95%CI:1.33-3.478), and 2.44(95% CI:1.39-4.32), respectively. Statin use (OR, 0.28; 95% CI: 0.25-0.5) and low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L (OR, 0.27; 95% CI: 0.14-0.53) had a significantly decreased risk of LIMA graft stenosis. While, only 15.4% (95/618) achieved the target LDL-C level.
Conclusions:
Postoperative smoking and hyperglycemia without diabetes had an increased risk of LIMA graft stenosis. Statin use and LDL-C <1.8 mmol/L decreased the risk.
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