Cascade plasma filtration during the first year after CABG in patients with hyperlipidemia refractory to statins |
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Authors: | Marat V. Ezhov Larisa N. Il'ina Maya S. Safarova Olga I. Afanasieva Irina Yu. Adamova Ruslan V. Atanesyan Gennadiy A. Konovalov Renat S. Akchurin Sergei N. Pokrovsky |
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Affiliation: | 1. Cardiology Research Center, 15a, 3rd Cherepkovskaya Street, 121552 Moscow, Russia;2. MEDSI Clinic, 3A, Georgian Lane, 123056 Moscow, Russia |
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Abstract: | ObjectiveTo evaluate the effect of a 12-month course of weekly lipid apheresis on vein graft patency after coronary artery bypass grafting (CABG) in patients with hyperlipidemia refractory to statins.MethodsIn a 12-month prospective controlled clinical trial we enrolled 34 male patients (mean age 57 ± 8 years) who passed through successful CABG and low-density lipoprotein cholesterol (LDL-C) level >2.6 mmol/L prior to the operation despite statin treatment. Patients were allocated into 2 groups: active (n = 17, weekly apheresis by cascade plasma filtration (CPF) plus atorvastatin), and control (n = 17, atorvastatin alone). Graft patency was evaluated by multislice computed tomography at 3 months and by angiography at 12 months after an operation.ResultsBoth groups were comparable in clinical and biochemical characteristics. During each CPF procedure, LDL-C level decreased by 64 ± 9%, apoB – by 65 ± 8%, Lp(a) – by 52 ± 15%,; these changes were significant compared to baseline and the control group. Mean net difference in LDL-C level between apheresis and control groups was 1.1 ± 0.3 mmol/L. Vein graft patency at study end was 88.2% (45 of 51) in the apheresis group versus 72.7% (40 of 55) in the control group (p = 0.05). Use of apheresis was associated with decreased vein graft occlusions by 46%: relative risk 0.54; 95% confidence interval 0.27 to 1.02; p = 0.05.ConclusionOur data suggest that the use of lipoprotein apheresis with CPF results in a better vein graft patency during the first year after CABG in patients with hyperlipidemia refractory to statins. |
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