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Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study
  1. Jing Gao1,2,
  2. Hai-Bo Wang3,
  3. Jian-yong Xiao4,
  4. Min Ren2,
  5. Kathleen Heather Reilly5,
  6. Yu-Ming Li1,
  7. Yin Liu4
  1. 1 Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
  2. 2 Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
  3. 3 Peking University Clinical Research Institute, Beijing, China
  4. 4 Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
  5. 5 Independent Consultant, New York, USA
  1. Correspondence to Professor Yu-Ming Li; cardiolab{at} and Professor Yin Liu; liuyin2088{at}


Objective The study aims to explore the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) level and saphenous vein grafts disease (SVGD) after coronary artery bypass grafting (CABG).

Design A cross-sectional study.

Setting A secondary hospital in Tianjin City, China.

Participants A total of 231 participants were included in the study. Inclusion criteria were as follows: age ≥18 years, previous CABG surgery at least 12 months ago, at least one SVG for bypass during CABG, abnormal non-invasive test results or recurrent stable angina pectoris by coronary angiography indications, and willing to participate and sign informed consent. Participants with any of the following were excluded from the study: congenital valvular disease, decompensated heart failure, anaemia defined as a haemoglobin level of <12 g/dL in women or <13 g/dL in men, malignant neoplasms, renal failure, severe hepatic disease, thyroid disease, acute or chronic inflammatory disease and chronic obstructive lung disease.

Primary outcome measure SVGD was defined as at least one SVG with significant stenosis (≥50%). Circulating PCSK9 levels were measured using commercial ELISA kits according to the manufacturer’s instructions.

Results The mean PCSK9 level in the SVGD group was significantly higher than that in the patent group (275.2±38.6 vs 249.3±37.7, p<0.01). The multivariate logistic regression model revealed a significant association between serum PCSK9 and SVGD (OR 2.08, 95% CI 1.46–2.95) per 1 SD increase in serum PCSK9.

Conclusions The present study is the first to identify an independent association between PCSK9 and late SVGD after adjustment for established cardiovascular risk factors. A multicentre prospective cohort study with large sample size should be conducted in the future to further research this relationship.

  • coronary artery bypass grafting
  • saphenous vein grafts disease
  • proprotein convertase subtilisin/kexin type 9 (pcsk9)
  • low-density lipoprotein cholesterol
  • atherosclerosis

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  • JG and H-BW contributed equally.

  • Contributors JG, YL, J-YX, and MR contributed to the development of the study protocol. JG and YL were the principal investigators and managed the protocol. JG, H-BW, KHR and Y-ML were involved in the initial draft of the manuscript and writing it. GJ and H-BW were involved in reviewing the manuscript. All authors read and approved the final manuscript.

  • Funding This research was funded by the Key Project of Scientific and Technological Support Plan of Tianjin in 2016 (no.: 16YFZCSY00800) and the Key Project of Healthcare Industry of Tianjin in 2015 (no.: 15KG128).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol and informed consent form were approved by the institutional review board of Tianjin Chest Hospital and the study was carried out in accordance with good clinical practices.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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