High Lp(a) may worsen long-term survival after TAVI despite similar 12-month MACCE, prospective cohort of 82 (Pol Arch Intern Med 2026)

Introduction: Severe aortic stenosis (AS) can be treated with transcatheter aortic valve implantation (TAVI). There is emerging evidence suggesting that high lipoprotein(a) (Lp[a]) levels may be associated with worse outcomes after TAVI.

Objectives: We aimed to compare major adverse cardiac and cerebrovascular events (MACCEs) within 12 months after TAVI and long‑term survival in patients with high and low Lp(a) levels.

Patients And Methods: In this prospective, multicenter cohort study we included patients with severe AS qualified for TAVI with stored plasma available for Lp(a) measurement. The patients were stratified into high- and low‑Lp(a) groups (cutoff, 30 mg/dl). Two primary end points were 12‑month MACCE and long‑term overall survival. Secondary end points were individual components of MACCE.

Results: Between November 2018 and September 2021, TAVI was performed across 3 clinical sites; stored plasma was available for Lp(a) level measurement in 82 patients. We observed no difference in MACCE occurrence in the high- and low‑Lp(a) groups. In unadjusted analyses, the patients with elevated Lp(a) levels had worse long‑term survival during median follow‑up of 2.8 years (log‑rank P = 0.045) but this difference lost significance after adjustments for age and sex in a Cox regression model (hazard ratio, 2.85; 95% CI, 0.85-9.55; P = 0.054). None of the secondary end points differed significantly between the groups.

Conclusions: The patients with elevated Lp(a) level had a comparable risk of 12‑month MACCE after TAVI to those with low Lp(a) level but might have worse long‑term survival. Long‑term findings should be considered exploratory and require further confirmation.