Elevated Lp(a) raises restenosis risk 3-fold after PCI, meta-analysis of twenty-six studies (J Clin Med 2026)

Background: Lipoprotein(a) [Lp(a)] is an inherited cardiovascular risk factor, but its relationship with coronary anatomical complexity, plaque phenotype, and outcomes after percutaneous coronary intervention (PCI) remains incompletely defined. Methods: We conducted a systematic review and meta-analysis of studies evaluating the association between circulating Lp(a) levels and coronary disease characteristics, post-PCI clinical outcomes, stent-related adverse outcomes, and aortic valve disease. Results: Twenty-six studies were included. Elevated Lp(a) levels were associated with greater coronary anatomical complexity and a higher risk of major adverse cardiovascular events after PCI (HR 1.4, 95% CI 1.2-1.7). The strongest associations were observed for stent-related adverse outcomes, including restenosis (OR 3.23, 95% CI 2.2-4.8) and target vessel revascularization (OR 2.6, 95% CI 1.6-4.4). Higher Lp(a) levels were also associated with vulnerable plaque features and aortic valve calcification. Conclusions: Elevated Lp(a) is associated with greater coronary disease complexity and adverse outcomes after PCI. Elevated Lp(a) may represent a biological marker identifying high-risk patients and providing additional insight for personalized risk stratification and procedural decision-making in patients undergoing PCI.