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Published on: September 22, 2020

Combined prognostic value of elevated lipoprotein(a) and severe calcification for limb outcomes after endovascular

Takeo Horikoshi1, Takamitsu Nakamura2, Toshiki Takei2

  • 1Department of Cardiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Japan. thorikoshi@yamanashi.ac.jp.

Heart and Vessels
|July 25, 2026
PubMed

Insights

Elevated Lipoprotein(a) [Lp(a)] and severe vascular calcification predict major adverse limb events (MALE) after endovascular therapy (EVT) in lower extremity arterial disease (LEAD). Combining these markers improves risk stratification for MALE outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Biomarkers and Diagnostics

Background:

  • Lower extremity arterial disease (LEAD) poses significant risks, with outcomes often poor after endovascular therapy (EVT).
  • Lipoprotein(a) [Lp(a)] and vascular calcification are independently linked to adverse events in LEAD.
  • A combined prognostic value of Lp(a) and calcification for major adverse limb events (MALE) post-EVT remains underexplored.

Purpose of the Study:

  • To investigate the combined prognostic significance of elevated Lp(a) and severe vascular calcification for MALE after EVT in LEAD patients.
  • To determine if integrating Lp(a) levels with the Peripheral Arterial Calcium Scoring System (PACSS) enhances risk stratification for MALE.

Main Methods:

  • Retrospective analysis of 145 patients who underwent EVT for LEAD.
  • Patients were stratified into groups based on the presence of elevated Lp(a) (≥30 mg/dL) and PACSS grade 4 (severe calcification).
  • One-year incidence of MALE was assessed as the primary endpoint, with hazard ratios (HR) and confidence intervals (CI) calculated.

Main Results:

  • MALE occurred in 17 patients within one year post-EVT.
  • A significant difference in MALE cumulative incidence was observed among groups stratified by Lp(a)/PACSS risk markers (P=0.032).
  • Patients with one or two risk markers showed significantly higher MALE risk (HR 3.175, P=0.038; HR 4.803, P=0.032) compared to those with none, with a significant trend (P=0.012).

Conclusions:

  • Elevated Lp(a) and severe vascular calcification, assessed by PACSS, identify a subgroup of LEAD patients at higher risk for MALE after EVT.
  • Combining Lp(a) measurement with anatomical assessment via PACSS may offer valuable insights for improved MALE risk stratification in LEAD patients undergoing EVT.

Keywords:
CalcificationEndovascular therapyLipoprotein(a)Lower extremity arterial diseaseMajor adverse limb events

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