Emerging Implications of Elevated Lipoprotein(a) Levels in Coronary Artery Bypass Graft Surgery

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-07-01 Epub Date: 2025-01-30 DOI:10.1016/j.athoracsur.2025.01.013

Shubh K. Patel , Miriam S. Badross , Nitish K. Dhingra MD , Michael Moroney , Jack H. Casey , Syed M. Ali Hassan MD , Tayyab S. Khan MD, MASc , David A. Hess PhD , Marlys L. Koschinsky PhD , Hwee Teoh PhD , Subodh Verma MD, PhD

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Abstract

Background

Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease (CAD). In nonurgent surgical revascularization cases, preoperative optimization of modifiable risk factors can improve outcomes. There is increasing interest in the relationship between lipoprotein(a) levels and the risk for ischemic cardiovascular disease, particularly how CABG outcomes are in turn affected. This review highlights the role of lipoprotein(a) in the pathogenesis of CAD and CABG outcomes and discusses future directions for its optimal management in the perioperative period.

Methods

The PubMed/MEDLINE database was reviewed until March 2024 to capture publications that evaluated and/or described the relationship between lipoprotein(a) and CABG surgery or CAD outcomes.

Results

The available literature supports lipoprotein(a) as a causal and independent risk factor for the pathogenesis of CAD. Elevated lipoprotein(a) levels are associated with an increased risk of adverse post-CABG outcomes, including graft occlusion incidence and major adverse cardiovascular events. Genetic variations influencing lipoprotein(a) levels play a role in disease progression and surgical outcomes. Several therapies aimed at reducing lipoprotein(a) levels, currently in phase III clinical trials, show promise for improving the prognosis after CABG.

Conclusions

Among individuals undergoing surgical revascularization for CAD, lipoprotein(a) levels may help define risk and inform best practices for perioperative management. We advocate for the routine measurement of lipoprotein(a) in all patients undergoing CABG. Emerging lipoprotein(a)-lowering agents show promise for secondary prevention of cardiac events, although dedicated analyses in cardiac surgical subcohorts will be important to evaluate their role in improving CABG outcomes.

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冠状动脉搭桥手术中脂蛋白(a)水平升高的新意义：一篇叙述性综述。

背景：冠状动脉旁路移植术（CABG）仍然是冠状动脉疾病（CAD）治疗的基石。在非紧急手术血运重建术病例中，术前优化可改变的危险因素可以改善预后。人们对脂蛋白(a)水平与缺血性心血管疾病风险之间的关系越来越感兴趣，特别是对冠状动脉搭桥结果的影响。这篇综述强调了Lp(a)在CAD和CABG发病机制中的作用，并讨论了其在围手术期最佳处理的未来方向。方法：对PubMed/MEDLINE数据库进行回顾，直到2024年3月，以获取评估和/或描述脂蛋白(A)与CABG手术或CAD结果之间关系的出版物。结果：现有文献支持脂蛋白(a)是冠心病发病的一个因果和独立的危险因素。脂蛋白(a)水平升高与冠脉搭桥后不良结局的风险增加相关，包括移植物闭塞发生率和主要不良心血管事件。影响脂蛋白(a)水平的遗传变异在疾病进展和手术结果中发挥作用。目前处于III期临床试验的几种旨在降低脂蛋白(a)水平的疗法显示出改善cabg后预后的希望。结论：在接受CAD手术血运重建术的个体中，脂蛋白(a)水平可能有助于确定风险并为围手术期管理提供最佳实践。我们提倡在所有接受CABG的患者中常规测量脂蛋白(a)。新兴的脂蛋白(a)降低药物显示出二级预防心脏事件的希望，尽管对心脏手术亚队列的专门分析对于评估它们在改善CABG结果中的作用很重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.