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HDL-Adjusted Inflammatory Ratios and Sequential Graft Configuration are Associated with Mid-Term Saphenous Vein Graft
Yusuf Hosoglu1, Hakan Tibilli2, Veysi Kavalci3
1Department of Cardiology, Private Koru Sincan Hospital, Ankara, Türkiye.
Insights
Elevated neutrophil-to-HDL ratio (NHDLr) and lymphocyte-to-HDL ratio (LHDLr) are linked to saphenous vein graft (SVG) occlusion after coronary artery bypass grafting (CABG). These inflammatory markers, along with sequential grafting, predict mid-term SVG failure.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Biomarkers
Background:
- Saphenous vein graft (SVG) failure is a major limitation for long-term outcomes following coronary artery bypass grafting (CABG).
- HDL-adjusted inflammatory ratios, such as neutrophil-to-HDL ratio (NHDLr) and lymphocyte-to-HDL ratio (LHDLr), are emerging markers of vascular inflammation.
- The association between these ratios and SVG occlusion post-CABG requires further investigation.
Purpose of the Study:
- To evaluate the association between HDL-adjusted inflammatory ratios (NHDLr, LHDLr) and mid-term SVG occlusion.
- To determine if sequential graft configuration is associated with SVG occlusion.
- To identify independent predictors of SVG occlusion in post-CABG patients.
Main Methods:
- A retrospective observational study of 190 post-CABG patients undergoing follow-up coronary angiography.
- Patients were classified based on the presence or absence of occluded SVGs.
- Multivariable logistic regression analysis was employed to identify predictors of SVG occlusion, utilizing HDL-adjusted ratios calculated from blood tests.
Main Results:
- Patients with SVG occlusion exhibited significantly higher NHDLr and LHDLr compared to those without occlusion.
- Sequential grafting was more prevalent in the SVG occlusion group (33.3% vs 11.9%).
- Independent predictors of SVG occlusion included sequential grafting (OR 3.58), female sex (OR 2.05), NHDLr (OR 1.18), and LHDLr (OR 1.39).
Conclusions:
- Elevated NHDLr and LHDLr, along with sequential grafting, are independently associated with mid-term SVG occlusion in post-CABG patients.
- These findings suggest that HDL-adjusted inflammatory ratios may serve as accessible biomarkers for graft vulnerability.
- Further validation is warranted to confirm the utility of these ratios in predicting SVG outcomes.
Background:
Saphenous vein graft (SVG) failure limits long-term outcomes after coronary artery bypass grafting (CABG). HDL-adjusted inflammatory ratios, including the neutrophil-to-HDL ratio (NHDLr) and lymphocyte-to-HDL ratio (LHDLr), have emerged as markers of vascular inflammation, but their association with SVG occlusion in the post-CABG setting is unclear. We evaluated whether HDL-adjusted inflammatory ratios and sequential graft configuration are associated with mid-term SVG occlusion.
Methods:
This retrospective observational study included 190 post-CABG patients who underwent clinically indicated follow-up coronary angiography. Patients were categorized by the presence (n=72) or absence (n=118) of at least one occluded SVG. HDL-adjusted ratios were calculated from fasting blood tests obtained at the outpatient visit when angiography was planned. Multivariable logistic regression was used to identify independent predictors of SVG occlusion.
Results:
Patients with SVG occlusion had higher NHDLr (5.07 vs 4.41, p=0.006) and LHDLr (2.48 vs 2.15, p=0.012). Median time from CABG to index angiography was 40.9 months (IQR 23.5-66.5). Sequential grafting was more frequent in the occlusion group (33.3% vs 11.9%, p<0.001). In multivariable analysis, sequential grafting (adjusted OR 3.58, 95% CI 1.63-7.85), female sex (OR 2.05, 95% CI 1.06-3.94), NHDLr (OR 1.18, 95% CI 1.01-1.38), and LHDLr (OR 1.39, 95% CI 1.04-1.87) were independently associated with SVG occlusion. The combined model showed moderate discrimination (AUC 0.729). SVG occlusion was not associated with all-cause mortality during follow-up (p=0.566).
Conclusion:
In a post-CABG cohort undergoing follow-up angiography, elevated NHDLr and LHDLr and sequential grafting were independently associated with mid-term SVG occlusion. These findings support further validation of HDL-adjusted inflammatory ratios as accessible markers related to graft vulnerability in this setting.
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