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Updated: Sep 26, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Mercaptoalbumin Is Associated with Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting
Maura Brioschi1, Erica Gianazza1, Daniele Andreini1,2
1Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.
Insights
Preoperative levels of human serum albumin thiol (HSA-SH), a key antioxidant, are lower in patients who experience graft occlusion after coronary artery bypass graft (CABG) surgery. Low HSA-SH independently predicts CABG graft occlusion, offering a potential therapeutic target.
Area of Science:
- Cardiovascular Surgery
- Biochemistry
- Oxidative Stress Research
Background:
- Coronary artery bypass graft (CABG) surgery is the standard for complex multivessel coronary artery disease.
- Graft occlusion is a significant complication following CABG.
- Oxidative stress is implicated in CABG graft failure.
Purpose of the Study:
- To investigate the association between preoperative levels of human serum albumin thiol (HSA-SH) and oxidized thiolated albumin (Thio-HSA) and graft occlusion after CABG.
- To determine if HSA-SH is an independent predictor of graft occlusion.
Main Methods:
- A nested case-control study was conducted.
- Included 36 patients with occluded grafts and 38 patients with patent grafts within 5 years post-CABG.
- Measured plasma levels of HSA-SH and Thio-HSA preoperatively.
Main Results:
- Preoperative HSA-SH levels were significantly lower in patients who developed graft occlusion compared to those with graft patency.
- Low HSA-SH remained a significant independent predictor of graft occlusion, even after adjusting for D-dimer levels.
- This suggests HSA-SH is a specific indicator for CABG graft outcomes.
Conclusions:
- Preoperative HSA-SH levels are independently associated with graft occlusion in CABG patients.
- HSA-SH represents a measurable and potentially targetable biomarker for predicting CABG graft failure.
- Further research into modulating HSA-SH could improve long-term CABG outcomes.
Abstract:
Coronary artery bypass graft (CABG) surgery still represents the gold standard for patients with complex multivessel coronary artery disease. However, graft occlusion still occurs in a significant proportion of CABG conduits, and oxidative stress is currently considered to be a potential contributor. Human serum albumin (HSA) represents the main antioxidant in plasma through its reduced amino acid Cys34, which can efficiently scavenge several oxidants. In a nested case-control study including 36 patients with occluded grafts and 38 age- and sex-matched patients without occlusion, we assessed the levels of the native mercaptoalbumin (HSA-SH) and oxidized thiolated form of albumin (Thio-HSA) in relation with graft occlusion within 5 years after CABG. We found that the plasma level of preoperative HSA-SH was significantly lower in patients with occluded graft at 5 years follow-up than in patients with graft patency. Furthermore, low HSA-SH remained independently associated with graft occlusion even after adjusting for preoperative D-dimer, a well-known marker of activated coagulation recently found to be associated with graft occlusion. In conclusion, the preoperative level of HSA-SH is independently associated with graft occlusion in CABG and represents a measurable and potentially druggable predictor.
