Evidence map›Paper›PMID 8992351›Full record

Trial reportThe New England journal of medicine1997

The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts.

Post Coronary Artery Bypass Graft Trial Investigators

Erratum issued 2 registry-linked trialsOpen access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 1997. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It reports registered trial NCT00000463. Cited by 162 papers, 23 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
162citing papers in PubMed, 23 pooled it
85.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00000463 phase3completed

Post Coronary Artery Bypass Graft (CABG) Study

Ran1987Registered outcomes0Posted comparisons0ConditionsCardiovascular Diseases, Coronary Disease, Heart Diseases, Myocardial IschemiaArmscholestyramine, lovastatin, warfarin
PMID 10532693PMID 11137831PMID 11092659PMID 10889125PMID 10385497PMID 10342818PMID 9863740PMID 9860374PMID 9402435PMID 9257071PMID 9114757PMID 8988902other papers from this trial
Open the trial in the graph
NCT00462436 phase2completednot on this mapstarted 2007, after this paper: background citation

Do Innovative Strategies Complement Medical Management to Reduce Cardiovascular Risk Factors Following Coronary Artery Bypass Graft Surgery?

TypeinterventionalSponsorUnity Health TorontoRan2007 to 2010Enrolled35ConditionsCoronary Artery Disease, Type II Diabetes MellitusArmsConsumption of Dietary Portfolio
3 · Its place in the literature

Who cites it

162 citing papers in PubMed, 23 syntheses or guidelines pooled it, 965 citations in OpenAlex.

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  7. Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2019
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  18. The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2008
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  19. Low density lipoprotein cholesterol, statins and cardiovascular events: a meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2006
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102 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

1 author at 1 institution in 1 country.

Post Coronary Artery Bypass Graft Trial InvestigatorsPost CABG Coordinating Center, Maryland Medical Research Institute, Baltimore 21210, USA.
Maryland Medical Research Institute · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundObstructive changes often occur in aortocoronary saphenous-vein bypass grafts because of atherosclerosis and thrombosis. We studied whether aggressive lowering of low-density lipoprotein (LDL) cholesterol levels or low-dose anticoagulation would delay the progression of atherosclerosis in grafts.

methodsWe studied 1351 patients who had undergone bypass surgery 1 to 11 years before base line and who had an LDL cholesterol level between 130 and 175 mg per deciliter and at least one patent vein graft as seen on angiography. We used a two-by-two factorial design to assign patients to aggressive or moderate treatment to lower LDL cholesterol levels (with lovastatin and, if needed, cholestyramine) and to treatment with warfarin or placebo. Angiography was repeated an average of 4.3 years after base line. The primary angiographic outcome was the mean percentage per patient of grafts with a decrease of 0.6 mm or more in lumen diameter.

resultsAs measured annually during the study period, the mean LDL cholesterol level of patients aggressive treatment ranged from 93 to 97 mg per deciliter; with moderate treatment, the range was from 132 to 136 mg per deciliter (P<0.001). The mean international normalized ratio was 1.4 in the warfarin group and 1.1 in the placebo group (P<0.001). The mean percentage of grafts with progression of atherosclerosis was 27 percent for patients whose LDL cholesterol level was lowered with aggressive treatment, and 39 percent for those who received moderate treatment (P<0.001). There was no significant difference in angiographic outcome between the warfarin and placebo groups. The rate of revascularization over four years was 29 percent lower in the group whose LDL cholesterol level was lowered aggressively than in the group receiving moderate treatment (6.5 percent vs. 9.2 percent, P= 0.03).

conclusionsAggressive lowering of LDL cholesterol levels to below 100 mg per deciliter reduced the progression of atherosclerosis in grafts. Low-dose warfarin did not reduce the progression of atherosclerosis.

Indexed as

Coronary Artery BypassAdultAgedAnticholesteremic AgentsAnticoagulantsCholesterol, LDLCholestyramine ResinCoronary AngiographyCoronary Artery DiseaseCoronary ThrombosisDrug Therapy, CombinationFemaleGraft Occlusion, VascularHumansHypercholesterolemiaLife TablesAnticholesteremic AgentsAnticoagulantsCholesterol, LDLCholestyramine ResinLovastatinWarfarin

Identifiers

PMID8992351
OpenAlexW137344628

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.