Epidemiology
Lp(a) of 50 mg/dL or above predicts MACE but not cardiovascular death after rotational atherectomy, unless it exceeds 68.3 mg/dL, 494-patient study finds (Catheter Cardiovasc Interv 2025)
Original title: Lipoprotein(a) and Coronary Calcification: Prognostic Implications in Rotational Atherectomy Patients
This retrospective study examined 494 consecutive patients undergoing rotational atherectomy for severe coronary calcification, stratified by Lp(a) below versus at or above 50 mg/dL, to clarify Lp(a)'s prognostic role in this specific procedural context. Kaplan-Meier analysis showed significantly higher major adverse cardiac event (MACE) incidence with Lp(a) 50 mg/dL or above (log-rank P = 0.006), but no significant difference in cardiovascular death (log-rank P = 0.062) at that threshold; using the minimum p-value method, the authors identified 68.3 mg/dL as the optimal threshold specifically for cardiovascular death, confirmed by survival analysis (log-rank P = 0.02). Lp(a) remained an independent MACE predictor after multivariate adjustment, and predicted higher MACE risk specifically in smokers and patients with comorbidities; age, haemodialysis, complications and heart failure were common risk factors for both outcomes. The authors conclude Lp(a) of 50 mg/dL or above independently predicts MACE, but only markedly elevated Lp(a) above 68.3 mg/dL predicts cardiovascular death, in this severely calcified, high-risk procedural population.
Original abstract
Background: Elevated Lipoprotein(a)[Lp(a)] concentrations have long been associated with an increased risk of major adverse cardiac events (MACE). However, the relationship of Lp(a) and clinical outcomes in patients with severe coronary calcifications undergoing rotational atherectomy (RA) remains unclear. This study aimed to explore the prognostic implications of Lp(a) in patients with calcified coronary lesions after RA.
Methods: Data from 494 consecutive patients undergoing RA were retrospectively collected. Lp(a) levels were stratified into two categories: < 50 mg/dL, and ≥ 50 mg/dL. Outcomes included MACE, and cardiovascular death (CVD).
Results: Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE in patients with Lp(a) ≥ 50 mg/dL (log-rank p = 0.006), but no significant difference was observed in the incidence of CVD (log-rank p = 0.062). We applied the minimum p-value method and identified an optimal threshold of 68.3 mg/dL for CVD, then further validated by survival analysis (log-rank p = 0.02). Multivariate Cox regression analysis showed Lp(a) remained an independent risk factor for MACE after adjusting for confounders. Age, hemodialysis, complications and heart failure were common risk factors for both MACE and CVD. Subgroup analysis indicated that Lp(a) predicted higher MACE risk in smokers and patients with comorbidities.
Conclusion: In patients with severe calcification undergoing RA, Lp(a) ≥ 50 ml/dL was independently associated with MACE but not with CVD, except when Lp(a) was markedly elevated (≥ 68.3 mg/dL). Additionally, Lp(a) was found to predict a higher risk of MACE in smokers and patients with comorbidities.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.