Epidemiology
Elevated Lp(a) (>30 mg/dL) raises long-term MACE risk by 31% after PCI for in-stent restenosis, in 2,086 patients (J Clin Lipidol 2023)
Original title: Association between lipoprotein(a) and long-term outcomes after percutaneous coronary intervention for lesions with in-stent restenosis
Among 2,086 patients undergoing percutaneous coronary intervention for in-stent restenosis (ISR) between 2017 and 2018, 834 had elevated Lp(a) (>30 mg/dL) and 1,252 did not. Over a median 36-month follow-up, major adverse cardiac events occurred in 26.7% of the elevated-Lp(a) group versus 21.8% of the non-elevated group (adjusted HR 1.31, 95% CI 1.08-1.58, P=0.007), driven by higher all-cause death (4.1% vs 2.5%, P=0.002; adjusted HR 1.77, 95% CI 1.07-2.94) and, to a lesser extent, repeat revascularisation (22.3% vs 19.5%, P=0.04). Adding Lp(a) to the risk model significantly improved discrimination and reclassification, and results were consistent across subgroups. The findings identify elevated Lp(a) as an independent predictor of worse long-term outcomes specifically in patients treated for in-stent restenosis.
Original abstract
Objectives: This study aimed to evaluate the association between increased lipoprotein (a) [Lp(a)] and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR).
Background: Elevated Lp(a) is demonstrated to be associated with recurrent ischemic events after PCI. However, the impact of Lp(a) in patients with ISR remains undetermined.
Methods: Between January 2017 and December 2018, a total of 2086 patients who underwent PCI for ISR were consecutively enrolled. Patients were categorized as elevated group (> 30 mg/dL, n=834) and non-elevated group (≤ 30 mg/dL, n=1252) according to baseline Lp(a) levels. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite endpoint of all-cause death, spontaneous myocardial infarction (MI), or repeat revascularization.
Results: During a median follow-up of 36 months, the primary outcome occurred in 202 of 1252 patients (26.7%) in the elevated Lp(a) group and 237 of 834 patients (21.8%) in the non-elevated Lp(a) group (adjusted hazard ratio: 1.31; 95% confidence interval: 1.08-1.58; P = 0.007), driven by higher rate of all-cause death (4.1% vs. 2.5%, P = 0.002 by Log-rank test; aHR: 1.77; 95% CI: 1.07-2.94; P = 0.03) and repeat revascularization (22.3% vs. 19.5%, P = 0.04 by Log-rank test; aHR: 1.18; 95% CI: 0.94-1.49; P = 0.16). Adding continuous or categorical Lp(a) to the Cox model led to a significant improvement in C-statistic, net reclassification, and integrated discrimination. The results were consistent across subgroups.
Conclusions: In the current cohort of patients who underwent PCI for ISR, elevated Lp(a) at baseline is associated with higher risk of long-term MACE.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.