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Residual Platelet Reactivity and Dyslipidemia in Post-CABG Patients Undergoing Repeat Revascularization: Insights

Aisulu Mussagaliyeva1, Sholpan Zhangelova1,2, Laura Danyarova1

  • 1Department of Postgraduate and Continuing Education, Scientific Research Institute of Cardiology and Internal Diseases, Almaty 050000, Kazakhstan.

Diseases (Basel, Switzerland)
|November 26, 2025
PubMed

Insights

High residual platelet reactivity and dyslipidemia predict repeat revascularization after coronary artery bypass grafting (CABG). Optimizing antiplatelet and lipid-lowering therapies is crucial for secondary prevention in high-risk patients.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Pharmacology

Background:

  • Coronary artery bypass grafting (CABG) is a standard treatment for advanced coronary artery disease (CAD).
  • A significant number of patients develop recurrent ischemia post-CABG, necessitating repeat revascularization.
  • Residual platelet reactivity (RPR) and dyslipidemia are identified as major contributors to graft failure and disease progression.

Purpose of the Study:

  • To investigate the prevalence and impact of RPR and dyslipidemia on outcomes in post-CABG patients.
  • To identify predictors of recurrent ischemia and graft failure in patients undergoing repeat angiography.
  • To evaluate the effectiveness of specific therapies, such as ezetimibe, in managing these risk factors.

Main Methods:

  • Observational study at a tertiary cardiology center in Kazakhstan.
  • Included 195 post-CABG patients with recurrent ischemic symptoms within 6-36 months post-surgery.
  • Analyzed clinical data, comorbidities, lipid profiles, and antiplatelet response (RPR via VerifyNow P2Y12 assay).

Main Results:

  • Elevated RPR was observed in 45% of patients despite dual antiplatelet therapy.
  • Poor lipid control, particularly high LDL-C, was common in patients requiring repeat percutaneous coronary intervention (PCI).
  • Both elevated RPR (OR=2.8) and dyslipidemia (OR=2.2) were independently associated with disease progression and graft failure. Ezetimibe use correlated with lower repeat stenting risk (OR=0.12).

Conclusions:

  • Residual platelet reactivity and dyslipidemia are significant predictors of repeat revascularization after CABG.
  • Prioritizing optimization of antiplatelet and lipid-lowering therapies is essential for secondary prevention.
  • Findings highlight the need for improved post-CABG management strategies, especially in Kazakhstan.
Abstract

Keywords:
Kazakhstancoronary artery bypass graftingdual antiplatelet therapydyslipidemiarepeat revascularizationresidual platelet reactivity

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