Lipoprotein(a) testing in invasive coronary angiography: Screening yield and anatomic coronary disease burden

Lipoprotein(a) [Lp(a)] is an inherited lipid-related risk factor that may be overlooked in invasive coronary practice. We assessed the yield of Lp(a) testing in patients undergoing coronary angiography and its association with anatomic coronary disease burden.

We performed a retrospective registry analysis of consecutive patients undergoing invasive coronary angiography between 15 June 2024 and 1 January 2026. Patients with available Lp(a) measurement were included. We assessed clinically relevant Lp(a) thresholds, reconstructed phase 3 trial-like frameworks for emerging Lp(a)-lowering therapies, and evaluated the association between Lp(a) ≥149 nmol/L and an anatomic complex coronary artery disease endpoint defined as SYNTAX score ≥23, chronic total occlusion, or left main disease. Index revascularization was excluded from this composite.

Among 2379 unique patients, 2230 had available Lp(a) measurement. Men accounted for 1508 (67.6%) and women for 722 (32.4%). The cohort was overwhelmingly White European, although race/ethnicity was not systematically recorded and exact proportions were unavailable. Lp(a) was ≥125, ≥149, ≥175 and ≥200 nmol/L in 473 (21.2%), 413 (18.5%), 330 (14.8%) and 255 (11.4%) patients, respectively. After conservative renal exclusion, 264 patients (11.8%) remained potential candidates for at least one major phase 3 trial-like framework. Lp(a) ≥149 nmol/L was associated with anatomic complex CAD (adjusted odds ratio 1.50, 95% confidence interval 1.16-1.94; p = 0.002).

In this male-predominant registry, Lp(a) elevation was common and identified a subgroup with trial-like screening relevance and greater anatomic CAD burden. Cross-sectional findings do not establish improved management or outcomes; generalizability by sex, age and ancestry requires prospective validation.