Combining Lp(a) and severe calcification predicts limb events after endovascular therapy for PAD, 145-patient study (Heart Vessels 2026)

Lipoprotein(a) [Lp(a)] and vascular calcification have each been associated with poor outcomes in lower extremity arterial disease (LEAD). This study investigated whether elevated Lp(a) levels and severe calcification have combined prognostic value for major adverse limb events (MALE) after endovascular therapy (EVT). We retrospectively analyzed 145 patients who underwent EVT. Patients were classified according to the number of Lp(a)/ Peripheral Arterial Calcium Scoring System (PACSS) risk markers: elevated Lp(a) (≥ 30 mg/dL) and PACSS grade 4. The primary endpoint was 1-year MALE incidence. MALE occurred in 17 patients during follow-up. Patients were classified into three groups according to the number of Lp(a)/PACSS risk markers. The cumulative incidence of MALE differed significantly among the three groups (overall P = 0.032). Compared with the 0 risk-marker group, the 1 risk-marker group and the 2 risk-marker group had significantly higher risks of MALE (hazard ratio [HR], 3.175; 95% confidence interval [CI], 1.064-9.475; P = 0.038; and HR, 4.803; 95% CI 1.146-20.128; P = 0.032, respectively). A significant trend toward higher MALE risk was observed with an increasing number of risk markers (P for trend = 0.012). Elevated Lp(a) and severe calcification may identify a subgroup at higher risk of MALE after EVT. Integrating Lp(a) measurement with anatomical assessment by PACSS may provide exploratory insights into risk stratification.