USEFULNESS OF LIPIDS, LIPOPROTEIN(A) AND FIBRINOGEN MEASUREMENTS IN IDENTIFYING SUBJECTS AT RISK OF OCCLUSIVE COMPLICATIONS FOLLOWING VASCULAR AND ENDOVASCULAR SURGERY

The study was designed to establish the usefulness of measuring lipopr otein(a) [Lp(a)], total cholesterol, triglycerides, low-density lipopr otein [LDL]-cholesterol, high-density lipoprotein [HDL]-cholesterol, t otal-to-HDL-cholesterol ratio and fibrinogen in identifying subjects a t risk of occlusive complications following vascular and endovascular surgery, including primary successful ileofemoral percutaneous translu minal angioplasty, infrainguinal and aortic bypass graft and carotid e ndarterectomy. A total of 68 volunteers subjected to vascular and endo vascular surgery were recruited to the study. Six months after success ful interventions, no occlusive complications verified by angiography were observed in 45 patients (66%; No-restenosis group), whereas signi ficant restenosis or reocclusion occurred in 23 patients (34%; Resteno sis group). Significant lower concentrations of Lp(a) (p=0.032), total cholesterol (p<0.0001), LDL-cholesterol (p=0.001) and total-to-HDL-ch olesterol ratio (p<0.0001) and higher concentrations of HDL-cholestero l (p=0.048) were observed in the No-restenosis group compared to the R estenosis group. The concentrations of triglycerides (p=0.080) and fib rinogen (p=0.510) did not differ significantly between groups. In mult ivariate discriminant analysis, the best predictors of restenosis or r eocclusion were in decreasing order: LDL-cholesterol, Lp(a), total-to- HDL-cholesterol ratio, HDL-cholesterol and total cholesterol. A statis tical difference of particular interest was observed in the overall di stribution of Lp(a) concentrations between groups (p<0.0001), occlusiv e complications being unlikely to occur in patients with Lp(a) concent rations below 50 mg L-1. The potential interference from a concurrent acute phase response, the most common source of elevation of Lp(a) in humans, was less likely in view of the absence of differences in eryth rocyte sedimentation rate between the No-restenosis and Restenosis gro ups (p = 0.463). In conclusion, the results of the present investigati on point to a definite role of the combined measurements LDL-cholester ol, Lp(a), total-to-HDL-cholesterol ratio, HDL-cholesterol and total c holesterol in the identification of subjects at risk of occlusive even ts following vascular and endovascular surgical procedures.