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.

Background: Optimal platelet inhibition is essential for minimizing both thrombotic and hemorrhagic complications in patients with coronary artery disease (CAD). Although high on-treatment platelet reactivity (HPR) has been consistently associated with adverse clinical outcomes, the relationship between platelet reactivity—measured as P2Y12 reaction units (PRU)—and cardiovascular mortality remains incompletely characterized. In particular, potential non-linear associations have not been adequately explored. Objective: We aimed to investigate the association between PRU and cardiovascular mortality in patients with CAD, with a specific focus on identifying potential non-linear relationships. Methods: We conducted a retrospective observational cohort study including 1000 patients with angiographically confirmed CAD treated at a tertiary cardiology center in Almaty, Kazakhstan, between 2024 and 2025. Platelet reactivity was assessed using the VerifyNow P2Y12 assay. Multivariable logistic regression models were used to identify independent predictors of cardiovascular mortality. To assess potential non-linear associations between PRU and mortality, restricted cubic spline regression was applied with predefined knot placement. Model performance was evaluated in terms of discrimination (C-statistic) and calibration (Hosmer-Lemeshow goodness-of-fit test). Results: In conventional linear regression models, PRU was not independently associated with cardiovascular mortality (odds ratio [OR] ~1.00; p > 0.05). However, spline-based analyses demonstrated a statistically significant non-linear (U-shaped) relationship between PRU and mortality risk (p for non-linearity = X). Both low and high PRU values were associated with increased mortality, whereas intermediate PRU levels corresponded to the lowest observed risk. Additional independent predictors of mortality included advanced age, diabetes mellitus, and elevated inflammatory markers. Conclusions: Our findings reveal a significant non-linear association between platelet reactivity and cardiovascular mortality in patients with CAD. Both insufficient and excessive platelet inhibition appear to confer increased risk, suggesting that optimal PRU targets may lie within an intermediate therapeutic range. These results support a paradigm shift toward more individualized antiplatelet therapy strategies guided by platelet function testing.

Background: High residual platelet reactivity (HRPR) and persistent dyslipidemia remain important unmet needs in cardiovascular risk management, particularly in patients undergoing coronary revascularization. Despite intensive lipid-lowering and antiplatelet therapy, a substantial proportion of patients fail to reach recommended low-density lipoprotein cholesterol (LDL-C) targets or exhibit inadequate platelet inhibition. Inclisiran, a PCSK9-targeting small interfering RNA, represents an emerging approach for long-term LDL-C reduction. Methods: A narrative review of the literature published between 2009 and 2025 was performed using PubMed, Scopus, Web of Science, and MEDLINE. Studies evaluating the addition of inclisiran to standard lipid-lowering therapy in patients with dyslipidemia and HRPR, assessed using the VerifyNow assay, were included. Illustrative clinical cases from Kazakhstan were analyzed to demonstrate real-world changes in LDL-C levels and platelet reactivity following insufficient response to conventional treatment. The review had a descriptive design. Results: Available evidence indicates that a significant proportion of high- and very-high-risk patients do not achieve LDL-C targets or are unable to tolerate high-intensity statin therapy. Inclisiran consistently induces sustained reductions in LDL-C and circulating PCSK9 levels. Emerging data suggest a potential indirect modulation of platelet reactivity associated with intensive lipid lowering. In patients at extreme cardiovascular risk—including those after coronary artery bypass grafting (CABG) and with long-standing multivessel coronary artery disease—inclisiran therapy was associated with marked LDL-C reduction and a trend toward normalization of platelet reactivity. Conclusions: Assessment of platelet function using the VerifyNow assay may improve identification of residual thrombotic risk in patients with advanced atherosclerotic disease. Inclisiran appears to be a promising adjunctive therapy for dyslipidemic patients with persistently elevated cardiovascular risk and HRPR despite standard treatment. Further prospective studies are warranted to clarify the relationship between intensive LDL-C lowering, platelet reactivity, and clinical outcomes, and to optimize integrated lipid-lowering and antiplatelet strategies.

Background:Recurrent ischemic symptoms after coronary artery bypass grafting (CABG) may require repeat percutaneous coronary intervention (PCI). Hypertension is common in coronary artery disease, but its value for predicting repeat revascularization after CABG is uncertain. High residual platelet reactivity (HRPR) may improve risk prediction. Objective: To evaluate the association of arterial hypertension and HRPR with repeat PCI after CABG in patients with recurrent ischemic symptoms. Methods: This retrospective single-center study included 195 patients with prior CABG evaluated for recurrent ischemic symptoms 6-36 months after surgery. Patients were stratified by repeat PCI status. HRPR was assessed using the VerifyNow assay; HRPR was defined as PRU≥208. Clinical and angiographic variables were analyzed using logistic regression. Results:Patients requiring repeat PCI were older and had extensive coronary artery disease and chronic kidney disease. Hypertension prevalence was similar between groups. PRU values were significantly higher in the repeat PCI group (230 vs 145, p<0.001), while HRPR was present in 66.2% of these patients and absent in those without repeat PCI. PRU remained associated with repeat PCI after adjustment. Conclusions: In post-CABG patients with recurrent ischemia, hypertension was not associated with repeat PCI, whereas HRPR showed a strong association with repeat revascularization. Введение:Рецидивирующая ишемия после аортокоронарного шунтирования (АКШ) может потребовать повторного чрескожного коронарного вмешательства (ЧКВ). Роль артериальной гипертензии в прогнозировании повторной реваскуляризации остается неясной, тогда как высокая остаточная реактивность тромбоцитов (ВОРТ) может иметь прогностическое значение. Цель: Оценить ассоциацию артериальной гипертензии и ВОРТ с повторным ЧКВ у пациентов после АКШ с рецидивирующими ишемическими симптомами. Материалы и методы: Ретроспективное одноцентровое исследование включило 195 пациентов после АКШ, обследованных через 6–36 месяцев по поводу рецидивирующей ишемии. Пациенты были разделены по наличию повторного ЧКВ. Реактивность тромбоцитов оценивали методом VerifyNow; HRPRопределяли как PRU ≥208. Данные анализировали с использованием логистической регрессии. Результаты:Пациенты, с повторным ЧКВ, были старше и чаще имели более тяжелое поражение коронарных артерий и хроническую болезнь почек. Частота артериальной гипертензии не различалась между группами. Уровни PRUбыли значительно выше в группе повторного ЧКВ (230 против 145; p<0,001). HRPRвыявлялась у 66,2% пациентов с повторным ЧКВ и отсутствовала в группе без него. PRUсохранял значимую ассоциацию с повторным ЧКВ после корректировки. Выводы: У пациентов после АКШ с рецидивирующей ишемией артериальная гипертензия не связана с повторным ЧКВ, тогда как ВОРТ ассоциируется с повышенным риском повторной реваскуляризации и может иметь прогностическую ценность. Кіріспе: Аортокоронарлық шунттау (АКШ) операциясынан кейін қайталанатын ишемиялық симптомдар қайталама тері арқылы коронарлық араласуды (ТКА) қажет етуі мүмкін. Артериялық гипертензияның қайталама реваскуляризацияны болжаудағы рөлі әлі толық анықталмаған, ал тромбоциттердің жоғары қалдық реактивтілігі (ТЖҚР) болжамдық мәнге ие болуы мүмкін. Мақсаты: АКШ-тан кейін қайталанатын ишемиялық симптомдары бар науқастарда артериялық гипертензия мен ТЖҚР -дың қайталама ТКА-мен байланысын бағалау. Материалдар мен әдістер: Ретроспективті бір орталықты зерттеуге АКШ операциясынан кейін 6–36 ай ішінде қайталанатын ишемияға байланысты тексерілген 195 науқас енгізілді. Науқастар қайталама ТКА-ның болуына қарай топтарға бөлінді. Тромбоциттердің реактивтілігі VerifyNow әдісімен бағаланды; ТЖҚР PRU ≥208 ретінде анықталды. Деректер логистикалық регрессия арқылы талданды. Нәтижелер: Қайталама ЧКВ жасалған науқастар жасы үлкен және коронарлық артериялардың айқын зақымдануы мен созылмалы бүйрек ауруы...