Residual Platelet Reactivity and Dyslipidemia in Post-CABG Patients Undergoing Repeat Revascularization: Insights from Kazakhstan

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.