Epidemiology
Elevated Lp(a) independently predicts lipid-rich, vulnerable coronary plaque on OCT in 202 ACS patients (Catheter Cardiovasc Interv 2025)
Original title: Coronary Plaque Characteristics Assessed by Optical Coherence Tomography and Plasma Lipoprotein(a) Levels in Patients With Acute Coronary Syndrome
This observational study included 202 consecutive patients admitted for acute coronary syndrome (ACS) undergoing OCT-guided PCI at a large tertiary centre between 2019 and 2022, split by Lp(a) below versus at or above 300 mg/L, to examine Lp(a)'s relationship with plaque morphology. Patients with elevated Lp(a) had a higher prevalence of lipid-rich plaques, a significantly greater mean lipid arc, more macrophage infiltration, and more thin-cap fibroatheroma (TCFA), while calcific plaque was more prevalent in the lower-Lp(a) group. Multivariable logistic regression identified both LDL-C of 70 mg/dL or above and elevated Lp(a) as strong independent predictors of lipid-rich plaques. The authors conclude elevated Lp(a) marks a more vulnerable coronary plaque phenotype, beyond LDL-C, positioning it as a useful marker for risk stratification and informing optimal medical management in ACS patients.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is associated with increased cardiovascular risk, but its influence on plaque characteristics at optical coherence tomography (OCT) evaluation is not fully understood.
Aims: This study seeks to explore the impact of Lp(a) levels on plaque morphology as assessed by OCT in a very high-risk subset of patients.
Methods: Consecutive patients admitted for acute coronary syndrome (ACS) and undergoing OCT-guided percutaneous coronary intervention (PCI) at a large tertiary care center between 2019 and 2022 were deemed eligible for the current analysis. The overall population was categorized into two subgroups according to baseline Lp(a) levels: (1) lower Lp(a) (Lp(a) ≤ 300 mg/L) and (2) elevated Lp(a) (Lp(a) ≥ 300 mg/L). Predictors of lipid-rich plaques were identified using multivariable logistic regression with stepwise selection of candidate covariates.
Results: A total of 202 patients were included in this study. OCT findings revealed that patients with elevated Lp(a) had a higher prevalence of lipid-rich plaques, a significantly greater mean lipid arc, along with increased macrophage infiltration and thin-cap fibroatheroma (TCFA). In contrast, calcific plaque prevalence was higher in the lower Lp(a) group. Multivariable regression analysis identified low-density lipoprotein cholesterol ≥ 70 mg/dL, and elevated Lp(a) as strong predictors of lipid-rich plaques at OCT.
Conclusion: In this observational study including ACS patients undergoing OCT-guided PCI, those with elevated Lp(a) levels exhibited a higher prevalence of lipid-rich plaques, increased macrophage infiltration, and TCFA, thereby indicating a more vulnerable plaque phenotype. Additionally, elevated Lp(a) levels and LDL-C levels ≥ 70 mg/dL were each independently associated with lipid enrichment of coronary plaques. These findings suggest Lp(a), beyond other well-known risk factors, as a key marker for risk stratification, potentially informing optimal medical management strategies.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.