Epidemiology
High Lp(a) raises death, MI, and stroke risk by 33-50% after PCI, meta-analysis of 40,241 patients across 14 studies finds (Arch Cardiovasc Dis 2025)
Original title: Association between lipoprotein(a) concentration and outcomes after percutaneous coronary intervention: A systematic review and meta-analysis
This systematic review and meta-analysis searched Ovid MEDLINE, EMBASE and the Cochrane Library for studies reporting outcomes after percutaneous coronary intervention (PCI) stratified by preoperative Lp(a) concentration, using each study's own high/low cut-off. Fourteen studies covering 40,241 patients were included; at a mean follow-up of 4.9 years, patients with high Lp(a) had significantly higher rates of all-cause death (incidence rate ratio 1.42, 95% CI 1.16-1.75, P < 0.001), myocardial infarction (IRR 1.45, 95% CI 1.18-1.78, P < 0.001), cardiovascular death (IRR 1.50, 95% CI 1.27-1.77, P < 0.001), major adverse cardiovascular events (IRR 1.35, 95% CI 1.19-1.54, P < 0.001) and stroke (IRR 1.33, 95% CI 1.13-1.56, P < 0.001) than patients with low Lp(a); leave-one-out and cumulative sensitivity analyses were consistent with the main findings. This large pooled analysis confirms Lp(a) as a robust marker of worse long-term outcomes across the full spectrum of PCI populations.
Original abstract
Background: Lipoprotein(a) is well known to be associated with the development of cardiovascular disease. Patients with an elevated baseline lipoprotein(a) concentration may be prone to unfavourable clinical outcomes following percutaneous coronary intervention.
Aim: We performed a study-level meta-analysis to evaluate differences in clinical outcomes after percutaneous coronary intervention in patients with high and low serum lipoprotein(a) concentrations.
Methods: A systematic literature search was conducted on Ovid MEDLINE, EMBASE and The Cochrane Library (Wiley) to identify studies reporting clinical outcomes in patients treated with percutaneous coronary intervention, stratified by preoperative lipoprotein(a) concentration. The lipoprotein(a) cut-off value of each individual study was considered for differentiation into low versus high lipoprotein(a) concentration groups. The primary outcome was all-cause death. Secondary outcomes were myocardial infarction, cardiovascular death, major adverse cardiovascular events and stroke.
Results: Fourteen studies (40,241 patients) were included. At a mean follow-up of 4.9 years, patients with high lipoprotein(a) concentrations had significantly increased rates of all-cause death (incidence rate ratio 1.42, 95% confidence interval 1.16-1.75; P<0.001), myocardial infarction (incidence rate ratio 1.45, 95% confidence interval 1.18-1.78; P<0.001), cardiovascular death (incidence rate ratio 1.50, 95% confidence interval 1.27-1.77; P<0.001), major adverse cardiovascular events (incidence rate ratio 1.35 95% confidence interval 1.19-1.54; P<0.001) and stroke (incidence rate ratio 1.33, 95% confidence interval 1.13-1.56; P<0.001) compared with patients with low lipoprotein(a) concentrations. Leave-one-out and cumulative analyses were consistent with the main analysis.
Conclusions: Among patients treated with percutaneous coronary intervention, high lipoprotein(a) concentrations are associated with higher rates of all-cause death, myocardial infarction, cardiovascular death, major adverse cardiovascular events and stroke compared with low lipoprotein(a) concentrations.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.