Residual Platelet Reactivity and Dyslipidemia in Post-CABG Patients Undergoing Repeat Revascularization: Insights from Kazakhstan
Mussagaliyeva A. Zhangelova S. Danyarova L. Nurmukhammad F. Kapsultanova D. Sakhov O. Rustamova F. Sugraliyev A. Akhmentayeva D.
November 2025Multidisciplinary Digital Publishing Institute (MDPI)
Diseases
2025#13Issue 11
Background: Coronary artery bypass grafting (CABG) remains a standard revascularization strategy for patients with advanced coronary artery disease (CAD). However, a considerable proportion of patients experience recurrent ischemia requiring repeat revascularization. Residual platelet reactivity (RPR) and dyslipidemia are recognized as key factors contributing to graft failure and disease progression. Methods: This observational study was conducted at a tertiary cardiology center in Kazakhstan. A total of 195 post-CABG patients who underwent repeat coronary angiography between 2023 and 2024 recruitment period for recurrent ischemic symptoms within 6–36 months after surgery were included. Clinical characteristics, comorbidities, lipid profiles, and antiplatelet response were analyzed. RPR was measured using the VerifyNow P2Y12 assay when available. Dyslipidemia was defined according to the 2019 and 2021 European guidelines. Results: Elevated RPR was identified in 45% of patients (n = 90) despite dual antiplatelet therapy (p < 0.01). Poor lipid control was frequent among those who underwent repeat percutaneous coronary intervention (PCI), particularly elevated levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (p < 0.05). Both elevated RPR and dyslipidemia were independently associated with native coronary disease progression and graft failure (RPR: OR = 2.8; 95% CI 1.4–5.6; p = 0.003; dyslipidemia: OR = 2.2; 95% CI 1.1–4.3; p = 0.02). The use of ezetimibe was independently associated with a significantly lower risk of repeat stenting (OR = 0.12; 95% CI 0.02–0.75; p = 0.023). Smokers were younger, had lower blood pressure, and less frequently presented with diabetes or chronic kidney disease, demonstrating a pattern consistent with the “smoker’s paradox.” Conclusions: Residual platelet reactivity and dyslipidemia are common and clinically relevant predictors of repeat revascularization after CABG. Optimization of antiplatelet and lipid-lowering therapy should be prioritized in secondary prevention for this high-risk population. These findings are particularly important in Kazakhstan, where post-CABG management strategies warrant further improvement.
coronary artery bypass grafting , dual antiplatelet therapy , dyslipidemia , Kazakhstan , repeat revascularization , residual platelet reactivity
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Department of Postgraduate and Continuing Education, Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 050000, Kazakhstan
Faculty of Postgraduate Education, Asfendiyarov Kazakh National Medical University, Almaty, 050012, Kazakhstan
Faculty of Postgraduate Medical Education, Hodja Ahmed Yasawi International Kazakh-Turkish University, Turkestan, 161200, Kazakhstan
Department of Postgraduate and Continuing Education
Faculty of Postgraduate Education
Faculty of Postgraduate Medical Education
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