High Lp(a) predicts worse outcomes but poor discrimination after drug-eluting stent PCI, meta-analysis of 27,618 (J Clin Lipidol 2026)

Original title: Predictive value of lipoprotein(a) in patients undergoing percutaneous coronary intervention with drug-eluting stent: A meta-analysis

J Clin Lipidol · 1 April 2026 · 6

Chuanchai W, Pajareya P, Siranart N, Phutinart S, Sowalertrat W, Laojindapun P, Techasatian W

Meta-analysis of eleven cohorts (27,618 patients, mean age 61±10.2, mean follow-up 4.5±1.98 years) undergoing percutaneous coronary intervention with drug-eluting stents, evaluating Lp(a)'s prognostic and diagnostic value. High Lp(a) was associated with increased risk of MACE (OR 1.25, 95% CI 1.09-1.42), myocardial infarction (OR 1.75, 95% CI 1.08-2.83), stroke (OR 1.28, 95% CI 1.04-1.59), cardiovascular mortality (OR 1.37, 95% CI 1.02-1.83) and all-cause mortality (OR 1.29, 95% CI 1.04-1.59). However, for predicting repeat revascularisation, target lesion revascularisation and target vessel revascularisation, Lp(a) showed modest sensitivity (46%, 35%, 39%) and specificity (64%, 74%, 79%), with AUROC values close to chance (0.527, 0.536, 0.537). The authors conclude high Lp(a) marks worse prognosis after drug-eluting stent PCI, but its discriminative value for repeat revascularisation remains inconclusive.

Original abstract

Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis. Drug-eluting stents (DES) were developed to delay the progression of atherosclerosis. However, the diagnostic and prognostic value of Lp(a) in patients undergoing percutaneous coronary intervention (PCI) with DES remains unknown.

Objective: We aim to evaluate the prognostic impact of serum Lp(a) level on cardiovascular outcomes and predictive value on repeat revascularization in patients undergoing PCI with DES.

Methods: We conducted a literature search from the inception of PubMed to May 2025. Eligible studies include adult patients, with the majority (>90%) undergoing PCI with DES. Primary outcomes were the prognostic value of Lp(a) in predicting major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular (CV) mortality, and all-cause mortality. Secondary outcomes were the diagnostic value of Lp(a) for repeat revascularization, target vessel revascularization (TVR), and target lesion revascularization (TLR) evaluated in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC).

Results: Eleven cohorts were included, comprising a total of 27,618 patients (mean age 61 ± 10.2 years, mean follow-up 4.5 ± 1.98 years). For primary outcomes, high Lp(a) level was associated with increased risks of MACE (odds ratio [OR] 1.25, 95% CI 1.09-1.42), MI (OR 1.75, 95% CI 1.08-2.83), stroke (OR 1.28, 95% CI 1.04-1.59), CV mortality (OR 1.37, 95% CI 1.02-1.83), and all-cause mortality (OR 1.29, 95% CI 1.04-1.59). For secondary outcomes, high Lp(a) level showed sensitivity of 46%, 35%, and 39% and specificity of 64%, 74%, and 79% in predicting repeat revascularization, TLR, and TVR, respectively. The AUROC for repeat revascularization, TLR, and TVR were 0.527, 0.536, and 0.537, respectively.

Conclusion: High Lp(a) level in patients who underwent PCI with DES was associated with poor prognosis; however, the predictive value of Lp(a) in this population remains inconclusive.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.