Baseline LDL-C and Lp(a) Elevations Portend a High Risk of Coronary Revascularization in Patients after Stent Placement

Abstract

Background and Aim. Incidence of coronary restenosis after stent placement is high. Our study was going to investigate whether Lp(a) elevation was potential for predicting coronary restenosis and whether the effects of Lp(a) elevation on coronary restenosis were dependent on LDL-C level. Methods and Results. Totally 832 participants eligible for stent placement were enrolled and followed up for monitoring clinical end points. Baseline characteristics were collected. According to the cut point of Lp(a), participants were divided into low Lp(a) group (Lp(a) < 30 mg/dL) and high Lp(a) group (Lp(a) ≥ 30 mg/dL). Furthermore, based on baseline LDL-C level, participants were divided into LDL-C < 1.8 mmol/L and ≥1.8 mmol/L subgroups. Clinical end points including major adverse cardiovascular events (MACE), cardiovascular death, nonfatal myocardial infarction, ischemic stroke, and coronary revascularization (CR) were compared. Patients in high Lp(a) groups more frequently presented with acute coronary syndrome and three vessel stenoses. In subgroup of LDL-C < 1.8 mmol/L, no significant differences of cardiovascular outcomes were found between low and high Lp(a) groups. While in the subgroup of LDL-C ≥ 1.8 mmol/L, incidences of MACE and CR were significantly higher in high Lp(a) group, and odds ratio for CR was 2.05. Conclusion. With baseline LDL-C and Lp(a) elevations, incidence of CR is significantly increased after stent placement.

Thrombin‐Induced Platelet‐Fibrin Clot Strength Identified by Thrombelastography

“…Elevated levels of LDL-C and LP(a) measured at the time stenting were associated with an increased risk for coronary revascularization (OR ¼ 2.05) in a study of 832 patients. 49 In another study of patients treated with stents (n ¼ 274), lower HDL levels (OR ¼ 1.028, P ¼ 0.047) and an increase in LDL particle size (OR ¼ 0.528, P ¼ 0.031) were independent predictors of ISR. 18 Although in our study, the Apo B 100:Apo A1 ratio was associated with ISR by univariate analysis, we found no independent utility of this marker in association with ISR.…”

“…The relation between lipoprotein levels and the development of restenosis have been previously investigated. Elevated levels of LDL‐C and LP(a) measured at the time stenting were associated with an increased risk for coronary revascularization (OR = 2.05) in a study of 832 patients . In another study of patients treated with stents (n = 274), lower HDL levels (OR = 1.028, P = 0.047) and an increase in LDL particle size (OR = 0.528, P = 0.031) were independent predictors of ISR .…”

Association of Lipoprotein (a) and Coronary Artery Lesion and In-hospital Outcomes in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…Indeed, prior studies showed that compared to those with low Lp(a), high Lp(a) was associated with more severe coronary artery stenosis as detected by angiography [28], and was also associated with less coronary collateral circulation in patients with acute myocardial infarction [29]. In addition, one study reported that increased Lp(a) at baseline was associated with a higher risk of stent restenosis and revascularization [11]. Two additional studies also showed that plasma Lp(a) concentration was an independent predictor of stent restenosis [30,31].…”

“…Traditional therapies such as statins targeting LDL-C have been unsatisfactory, and many studies found that increased lipoprotein (a) [Lp(a)] level was associated with cardiovascular events [9][10][11][12]. Lp(a) is a LDL-like particle synthesized in the liver [13].…”

“…Serum Lp(a) level is predominantly dependent on the number of repeats in the kringle IV type 2 protein domain [13]. Numerous studies have shown that increased serum Lp(a) level portends a higher cardiovascular risk [9][10][11][12]. Unfortunately, statins treatment has no effects on Lp(a) reduction [13,14].…”