Lipoprotein(a) and Coronary Calcification: Prognostic Implications in Rotational Atherectomy Patients

Elevated Lipoprotein(a)[Lp(a)] concentrations have long been associated with an increased risk of major adverse cardiac events (MACE). However, the relationship of Lp(a) and clinical outcomes in patients with severe coronary calcifications undergoing rotational atherectomy (RA) remains unclear. This study aimed to explore the prognostic implications of Lp(a) in patients with calcified coronary lesions after RA.

Data from 494 consecutive patients undergoing RA were retrospectively collected. Lp(a) levels were stratified into two categories: < 50 mg/dL, and ≥ 50 mg/dL. Outcomes included MACE, and cardiovascular death (CVD).

Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE in patients with Lp(a) ≥ 50 mg/dL (log-rank p = 0.006), but no significant difference was observed in the incidence of CVD (log-rank p = 0.062). We applied the minimum p-value method and identified an optimal threshold of 68.3 mg/dL for CVD, then further validated by survival analysis (log-rank p = 0.02). Multivariate Cox regression analysis showed Lp(a) remained an independent risk factor for MACE after adjusting for confounders. Age, hemodialysis, complications and heart failure were common risk factors for both MACE and CVD. Subgroup analysis indicated that Lp(a) predicted higher MACE risk in smokers and patients with comorbidities.

In patients with severe calcification undergoing RA, Lp(a) ≥ 50 ml/dL was independently associated with MACE but not with CVD, except when Lp(a) was markedly elevated (≥ 68.3 mg/dL). Additionally, Lp(a) was found to predict a higher risk of MACE in smokers and patients with comorbidities.