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  • Title: Lipoprotein(a) and long-term in-stent restenosis after percutaneous coronary intervention.
    Author: Mahmoud AK, Farina JM, Awad K, Ali NB, Pereyra M, Scalia IG, Abbas MT, Allam MN, Kamel MA, Abu Rmilah AA, Chao CJ, Barry T, Alsidawi S, Lester SJ, Pollak PM, Alkhouli MA, Lee KS, Yang EH, Lee RW, Sweeney JP, Fortuin DF, Ayoub C, Arsanjani R.
    Journal: Eur J Prev Cardiol; 2024 Nov 11; 31(15):1878-1887. PubMed ID: 38916491.
    Abstract:
    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. The role of lipoprotein(a) [Lp(a)] in the development of in-stent restenosis is not clearly established. In this study including 1209 patients who underwent successful percutaneous coronary intervention and had a preprocedural Lp(a) measurement between 2006 and 2017, the rates of restenosis were significantly higher among patients with high Lp(a) vs. patients with low Lp(a) values, and high Lp(a) concentrations were independently associated with restenosis events. Lipoprotein(a) should be considered as a risk factor for long-term in-stent restenosis in the evaluation of patients undergoing percutaneous coronary intervention and assessed as a potential therapeutic target for reducing residual cardiovascular risk in this population.
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