Hyperacute-phase Lp(a) predicts intracoronary thrombus, stable-phase Lp(a) predicts layered plaque, OCT study of 142 (Coron Artery Dis 2026)

Original title: Lipoprotein(a)-associated thrombus formation and plaque healing in acute coronary syndromes: insights from optical coherence tomography

Coron Artery Dis · 3 April 2026 · 6

Shibata Y, Kurihara O, Kobayashi N, Okajima F, Takano M, Asai K

Study of 142 patients with acute coronary syndrome undergoing optical coherence tomography (OCT) during PCI, with Lp(a) measured in the hyperacute (n=58), acute (n=125) or stable (n=51) phase, testing phase-specific Lp(a) against angiographic and OCT findings. Patients with intracoronary thrombus had higher hyperacute-phase Lp(a) than those without (10.2 vs 3.7 mg/dL, p=0.033), and a greater rise in Lp(a) from hyperacute to acute phase was associated with thrombus presence (12.1 vs 2.35 mg/dL, p=0.027). Conversely, patients with layered plaque on acute-phase OCT had lower stable-phase Lp(a) than those without (4.1 vs 13.0 mg/dL, p=0.014); acute-phase Lp(a) itself showed no significant associations. The authors conclude elevated hyperacute Lp(a) marks intracoronary thrombus while low stable-phase Lp(a) marks layered (healed) plaque, suggesting stable-phase Lp(a) better reflects baseline biology and prior subclinical events.

Original abstract

Background: Elevated lipoprotein(a) levels are associated with myocardial infarction; however, in-vivo evidence linking lipoprotein(a) to intracoronary thrombosis remains limited. We evaluated phase-specific lipoprotein(a) levels during the hyperacute, acute, and stable phases of acute coronary syndrome and their associations with angiographic and optical coherence tomography findings.

Methods: We analyzed 142 patients with acute coronary syndrome who underwent optical coherence tomography during percutaneous coronary intervention and for whom lipoprotein(a) was measured in the hyperacute (n = 58), acute (n = 125), or stable (n = 51) phases.

Results: Baseline demographics, laboratory data, angiographic findings, and optical coherence tomography characteristics were similar across phases. Patients with intracoronary thrombus had significantly higher hyperacute-phase lipoprotein(a) levels than did those without [10.2 (interquartile range: 5.4-18.8) vs. 3.7 (3.0-10.3) mg/dl; P = 0.033]. In addition, a greater increase in lipoprotein(a) from the hyperacute to the acute phase was associated with thrombus presence [12.1 (4.0-18.4) vs. 2.35 (0.0-7.1) mg/dl; P = 0.027]. Conversely, patients with layered plaque on acute-phase optical coherence tomography demonstrated significantly lower stable-phase lipoprotein(a) levels than did those without [4.1 (3.0-7.1) vs. 13.0 (5.7-21.3) mg/dl; P = 0.014]. No significant associations were observed for acute-phase lipoprotein(a) levels.

Conclusion: Elevated hyperacute-phase lipoprotein(a) levels were associated with intracoronary thrombus, whereas low stable-phase lipoprotein(a) levels were associated with layered plaque. These phase-specific relationships suggest that lipoprotein(a) influences thrombosis and plaque healing in acute coronary syndrome, and that stable-phase lipoprotein(a) levels may better reflect baseline biology and help identify prior subocclusive events.

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