The First Results of the Secondary Prevention after Coronary Artery Bypass Grafting |
G.Chapidze,
S.Kapanadze, N.Dolidze, Z.Bakhutashvili
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Key words: Coronary artery disease, coronary artery bypass, revascularization. Coronary artery bypass graft (CABG)
surgery remains the procedure of choice for patients with diffuse disease,
left main coronary artery disease and for a large number of patients with
multivessel disease, among
whom the completeness of revascularization is the major objective with
regard to long-term prognosis. Unfortunately, after CABG procedure, rapid
development of arteriosclerosis may cause stenosis
and occlusion in the venous grafts. This problem is actual for our
clinic, where already around 190 bypass operations were performed. Subsequently,
as the maintenance of CABG results is not less important that the method
of myocardial revascularization, there is the urgent necessity to
establish a system for secondary coronary prevention and prophylaxis of
coronary insufficiency. The
research was carried out in 127 patients who in 2001-2002 underwent CABG
operations. The frequency of the main risk factors, drug therapy, dynamics
in functional class of angina, left ventricular ejection
fraction and parameters of lipid profile were studied. Among the
main risk factors hyperlipidemia was prevailing - it was found in 81% of
patients. Particular attention was paid to the elevated levels of LDL-C
(78%) - the most important risk factor for development of stenosis and
occlusion in coronary
arteries and bypass grafts.
We observed 0-1 risk factor in 69% of cases, 2 and more-in 31%. Aspirin
and statins were the first line agents in patients after direct myocardial
revascularization. Aspirin use was almost universal-94% of patients
receiving it. Statins were used in 84% of cases. There were 2 cases of
occlusion of vein grafts diagnosed by angiography 10 months post CABG.
These 2 patients had II-III functional class of angina. In 32 patients
left ventricular ejection fraction measured by echocardiography was
increased by 6%. Lipid
parameters were defined in 34 patients prior to and 1,5,9 and 11 weeks
post bypass surgery. According to our investigations one week after CABG
there were highly significant percent reductions in TC, LDL-C, TG and HDL-C
(31%, 34%, 35% and 12%, respectively). From week 5 there was a marked
tendency of to lipid increase and only 11 weeks after operation all
atherogenic lipid fractions return to their baseline levels. The data
obtained suggest that blood lipids should be assessed 5 to 11 weeks post
CABG, as all parameters of lipid profile may be depressed after this major
surgical procedure. Measurements made earlier than 5 to 11 weeks post
bypass for initiation of lipid lowering therapy should be viewed with
respect to these observations. In
conclusion for the future: These are the first results of our study, as
direct myocardial revascularization is a brand new method of treatment
used in our country. The end-points that need secondary prevention after
CABG are: cardiac death, recurrent coronary events and also recurrent
coronary revascularization by surgical or percutaneous means.
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