Abstract

Objective: It has earlier been suggested that postoperative thrombocytosis frequently occur after CABG and may be linked to lipid disturbances. A prospective randomized study was undertaken to evaluate if preoperative lipid-control, using HMG-CoA-reductase inhibitor (Zocor®), reduces the risk of postoperative thrombocytosis.

Material: Seventy-seven patients with symptomatic coronary artery disease and hypercholesterolemia (Tot. Chol. => 6.2 mmol/L), planned for CABG where randomly assigned to; undergo CABG without preop. lipid control (Gr. I, N = 37) or undergo Zocor-treatment to control their lipids (4 weeks) prior to CABG (Gr. II, N = 40). Patient characteristics and operation data did not differ between the groups. Serum-Cholesterol, Chol./HDL-Chol., LDL-Chol., Apolipoprotein A1 and Plasminogen were all significantly higher in Group I patients compared to Gr. II just prior to surgery. Other laboratory parameters did not differ.

Results: In Gr. II, total Cholesterol and Chol/HDL-Chol quota were significantly lowered by Zocor (-24.6% and -29.3% resp.) Postoperative thrombocytosis (platelet counts => 400,000/ul) occurred significantly more frequently in Gr. I 83.8% (31/37) compared to 2.5% (1/40) in Gr. II, p < 0.001. Myocardial infarction after the 7th postop. day was more often diagnosed in Gr. I, 16.2% vs. 0.0% in Gr. II. Postop. transient renal failure occured also more frequently in Gr. I, 23.6% compared to 7.5% in Gr. II, p < 0.05. Other postoperative complications and laboratory data did not differ.

Conclusions: This study once again underlines the importance of lipid control using HMG-CoA-reductase inhibitors (eg. Zocor®) in patients with established coronary artery disease. For the first time it is shown that lipid-cotrol prior to CABG reduces the risk of postoperative thrombocytosis, thus lowers the risk for thrombotic complications.