Hyperlipoproteinemia(a) and Severe Coronary Artery Lesion Types

Abstract

Diffuse atherosclerosis and calcification of the coronary arteries (CA) create serious difficulties for coronary artery bypass grafting (CABG). The aim of this study was to compare demographic indicators, lipids, and clinical results one year after CABG in patients with different phenotypes of coronary artery (CA) disease. In total, 390 patients hospitalized for elective CABG were included in a single-center prospective study. Demographic data, lipids (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), and lipoprotein(a) (Lp(a)) concentrations were analyzed for all patients. Major adverse cardiovascular events (MACE) included myocardial infarction, stroke, percutaneous coronary intervention, and death from cardiac causes within one year after surgery. No significant outcome differences were found between the groups with diffuse vs. segmental lesions, nor the groups with and without calcinosis for all studied parameters except for Lp(a). Median Lp(a) concentrations were higher in the group of patients with diffuse compared to segmental lesions (28 vs. 16 mg/dL, p = 0.023) and in the group with calcinosis compared to the group without it (35 vs. 19 mg/dL, p = 0.046). Lp(a) ≥ 30 mg/dL was associated with the presence of diffuse lesions (OR = 2.18 (95% CI 1.34-3.54), p = 0.002), calcinosis (2.15 (1.15-4.02), p = 0.02), and its combination (4.30 (1.81-10.19), p = 0.0009), irrespective of other risk factors. The risk of MACE within one year after CABG was higher for patients with combined diffuse and calcified lesions vs. patients with a segmental lesion without calcinosis (relative risk = 2.38 (1.13-5.01), p = 0.02). Conclusion: Diffuse atherosclerosis and coronary calcinosis are associated with elevated Lp(a) levels, independent of other risk factors. The risk of MACE in the first year after surgery is significantly higher in patients with diffuse atherosclerosis and coronary calcinosis, which should be considered when prescribing postoperative treatment for such patients.

Keywords: coronary artery calcinosis; coronary bypass grafting; diffuse atherosclerosis; lipoprotein(a).

Figure 1

Lp(a) concentration in subgroups with different types of coronary arteries lesions. 1—segmental lesion without calcinosis, 2—diffuse lesion without calcinosis, 3—segmental with calcification, 4—diffuse with calcinosis. The data are presented as Box and Whisker graph. The circles indicate values outside the Q3 + 1.5 interquartile range (IQR), the red squares—values exceeding Q3 + 3 IQR.

Figure 2

Distribution of different types of coronary artery lesions depending on the Lp(a) concentration. Subgroup 1—segmental lesion without calcinosis, subgroup 2—diffuse lesion without calcinosis, subgroup 3—segmental with calcification, subgroup 4—diffuse with calcinosis.

Figure 3

Concentration of LDL-C (a) and LDL-Ccorr (b) in subgroups of patients with different types of coronary artery lesions. 1—Segmental lesion without calcinosis, 2—diffuse lesion without calcinosis, 3—segmental with calcification, 4—diffuse with calcinosis. The circles indicate values outside the 1.5 IQR relative to the upper Q3 or lower Q1 quartiles; the red squares-values outside 3 IQR.

Figure 4

Proportion of patients with or without MACE in the first year after surgery. 1—Segmental lesion without calcinosis, 2—diffuse lesion without calcinosis, 3—segmental with calcification, 4—diffuse with calcinosis.