Background
High lipoprotein (a) [Lp(a)] levels are an independent factor for worse prognosis in patients with coronary artery disease (CAD). However, the association between serum Lp(a) level and coronary plaque vulnerability remains to be determined.
Methods
A total of 255 consecutive patients with CAD who underwent optical coherence tomography imaging of culprit lesions were included. Patients were divided into 2 groups according to their Lp(a) levels (the higher Lp(a) group [≥25 mg/dL],
n
= 87; or the lower Lp(a) group [<25 mg/dL],
n
= 168).
Results
The prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in the higher Lp(a) group than in the lower Lp(a) group (23% [
n
= 20] vs. 11% [
n
= 19],
p
= 0.014). Although the prevalence of TCFA was comparable between the 2 groups among patients with a lower LDL cholesterol (LDL-C) level (<100 mg/dL), TCFA was significantly more prevalent in the higher Lp(a) group than in the lower Lp(a) group (39% [14/36] vs. 10% [5/50],
p
= 0.001) among patients with a higher LDL-C level (≥100 mg/dL).
Conclusions
A higher Lp(a) level was associated with a higher frequency of TCFA, particularly in patients with a higher LDL-C level.
Subjects This was an observational study conducted at a single center with Japanese patients. A total of 1,021 culprit lesions in 1,021 patients who underwent optical coherence tomography (OCT) and percutaneous coronary intervention (PCI) between February 2013 and March 2019 at Kitasato University Hospital (Sagamihara, Japan) were identified. Of these, a total of 860 patients with 860 de novo lesions (171 female and 689 male) were enrolled in the present study after excluding cases of restenosis (n=132) and poor OCT of culprit lesions (n=29; Supplementary Figure 1). Because the median age in this cohort was 69 years (IQR, 60-78 years), "younger" and "elderly" were defined as <70 years old and ≥70 years old, respectively. All patients provided written informed consent for the procedure, and this study was conducted in compliance with the Declaration of Helsinki and approved by the institutional ethics committee.
Serum syndecan-1 level is not associated with angiographic coronary severity.• Lower syndecan-1 is associated with higher prevalence of vulnerable plaque.• Impairment of glycocalyx might be involved in the development of vulnerable plaque.
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