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.

Background: Coronary artery bypass grafting (CABG) is a standard treatment for ad-vanced coronary artery disease (CAD). Despite its effectiveness, many patients devel-op recurrent ischemia requiring repeat revascularization. Residual platelet reactivity (RPR) and dyslipidemia are considered important contributors to graft failure and dis-ease progression. This study investigated the association of RPR and dyslipidemia with repeat revascularization in post-CABG patients. Methods: A observational cohort study was performed at a tertiary cardiology center in Kazakhstan. A total of 200 patients with prior CABG who underwent repeat coro-nary angiography between 2023 and 2024 for recurrent ischemic symptoms were in-cluded. Clinical data, comorbidities, lipid profiles, and antiplatelet response were ana-lyzed. RPR was measured with the VerifyNow P2Y12 assay where available. Dyslipidemia was defined according to current European guidelines, 2019/2021. Results: Elevated RPR was found in 45% (n = 90) of patients despite dual antiplatelet therapy. Poor lipid control, especially increased low-density lipoprotein cholesterol (LDL-C) and total cholesterol was common among patients undergoing repeat percu-taneous coronary intervention (PCI). Both RPR and dyslipidemia were independently associated with native coronary disease progression and graft failure. Conclusions: RPR and dyslipidemia are frequent and clinically relevant predictors of repeat revascularization after CABG. Optimizing antiplatelet and lipid-lowering ther-apy should be a priority in secondary prevention for this high-risk group. These results are particularly important in the Central Asian setting, where post-CABG management strategies require further improvement.

The aim of the study was to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure. Materials and methods: Seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test and clinical assessment scale modified by Mareev, before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration ≥ 130 ms. and left ventricular ejection fraction ≤ 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study. Results: We observed significant increase in left ventricular ejection fraction (35.4±3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (20.2 ±3.0 %, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by > 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms. Conclusions: The response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant. Key words: congestive heart failure, cardiac resynchronizing therapy, optimal drug therapy.