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Lipoprotein(a) and long-term in-stent restenosis after percutaneous coronary intervention
Ahmed K Mahmoud1, Juan M Farina1, Kamal Awad1
1Department of Cardiovascular Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
Insights
High Lipoprotein(a) [Lp(a)] levels are linked to increased risk of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Lp(a) is an independent predictor for long-term ISR, guiding patient evaluation post-PCI.
Area of Science:
- Cardiology
- Biochemistry
- Medical Research
Background:
- Lipoprotein(a) [Lp(a)] is associated with atherosclerosis and myocardial infarction.
- The role of Lp(a) in in-stent restenosis (ISR) following percutaneous coronary intervention (PCI) requires further clarification.
Purpose of the Study:
- To investigate the association between Lp(a) levels and the development of ISR after PCI.
Main Methods:
- Retrospective study of 1209 adult patients undergoing successful PCI.
- Patients categorized into high Lp(a) (≥ 50 mg/dL) and low Lp(a) (< 50 mg/dL) groups.
- Univariable and multivariable analyses to assess ISR risk.
Main Results:
- ISR observed in 13.4% of patients.
- Higher median Lp(a) levels in ISR patients (27 mg/dL) vs. non-ISR patients (20 mg/dL).
- High Lp(a) group showed significantly higher ISR rates (17.0% vs. 11.6%) and was independently associated with ISR events (HR 1.67).
Conclusions:
- Lipoprotein(a) is an independent predictor of long-term ISR.
- Lp(a) levels should be considered in evaluating patients undergoing PCI.
Aims:
Lipoprotein(a) [Lp(a)] has demonstrated its association with atherosclerosis and myocardial infarction. However, its role in the development of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) is not clearly established. The aim of this study is to investigate the association between Lp(a) and ISR.
Methods And Results:
A retrospective study of adult patients who underwent successful PCI between January 2006 and December 2017 at the three Mayo Clinic sites and had a preprocedural Lp(a) measurement was conducted. Patients were divided into two groups according to the serum Lp(a) concentration [high Lp(a) ≥ 50 mg/dL and low Lp(a) < 50 mg/dL]. Univariable and multivariable analyses were performed to compare risk of ISR between patients with high Lp(a) vs. those with low Lp(a). A total of 1209 patients were included, with mean age 65.9 ± 11.7 years and 71.8% were male. Median follow-up after baseline PCI was 8.8 [interquartile range (IQR) 7.4] years. Restenosis was observed in 162 (13.4%) patients. Median serum levels of Lp(a) were significantly higher in patients affected by ISR vs. non-affected cases: 27 (IQR 73.8) vs. 20 (IQR 57.5) mg/dL, P = 0.008. The rate of ISR was significantly higher among patients with high Lp(a) vs. patients with low Lp(a) values (17.0% vs. 11.6%, P = 0.010). High Lp(a) values were independently associated with ISR events (hazard ratio 1.67, 95% confidence interval 1.18-2.37, P = 0.004), and this association was more prominent after the first year following the PCI.
Conclusion:
Lipoprotein(a) is an independent predictor for long-term ISR and should be considered in the evaluation of patients undergoing PCI.
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