Inflammation
Lp(a) ≥175 nmol/L associates with greater coronary lesion burden and multivessel disease in acute coronary syndrome (J Lipid Res 2026)
Original title: Lipoprotein(a) and the C-reactive protein-triglyceride-glucose index in relation to coronary lesion burden in patients with acute coronary syndrome
This retrospective, single-center cohort of 2,836 patients with acute coronary syndrome examined the association between lipoprotein(a) and angiographic coronary lesion burden. Compared with Lp(a) <75 nmol/L, Lp(a) ≥175 nmol/L was associated with a high Gensini score (OR, 1.51 [95% CI, 1.17-1.96]) and multivessel disease (OR, 1.69 [95% CI, 1.27-2.26]). The inflammatory-lipid C-reactive protein-triglyceride-glucose index provided the largest numerical incremental discrimination beyond Lp(a), and the association between very high Lp(a) and lesion burden was more pronounced at higher index levels. The finding confirms the gradient of risk with elevated Lp(a) in ACS, though methodological constraints limit clinical translation.
Original abstract
Background: Lipoprotein(a) [Lp(a)] reflects inherited atherothrombotic risk, whereas the C-reactive protein-triglyceride-glucose index (CTI) integrates systemic inflammation, triglyceride-related lipid disturbance, and glucose-related metabolic stress. Their individual and joint association with angiographic coronary lesion burden in acute coronary syndrome (ACS) remain incompletely defined. We examined whether CTI complements Lp(a) in characterizing coronary lesion burden in ACS.
Materials And Methods: This retrospective, single-center study included 2,836 consecutive patients with ACS who underwent coronary angiography. Coronary lesion burden was assessed using continuous Gensini score, a high Gensini score, and multivessel disease (MVD). Multivariable regression, restricted cubic spline analyses, CTI-stratified analyses, incremental receiver operating characteristic analyses, and internally validated machine-learning analyses with SHAP interpretation were performed.
Results: Higher Lp(a) and CTI level were both associated with greater coronary lesion burden. Compared with Lp(a) <75 nmol/L, Lp(a) ≥175 nmol/L was associated with high Gensini score (OR, 1.51 [95% CI, 1.17-1.96]) and MVD (OR, 1.69 [95% CI, 1.27-2.26]). Each 1-SD increase in CTI was associated with high Gensini score (OR, 1.47 [95% CI, 1.35-1.60]) and MVD (OR, 1.18 [95% CI, 1.08-1.28]). Among inflammatory-lipid indices, CTI showed the most consistent associations and provided the largest numerical incremental discrimination beyond Lp(a). The associaton between ver high Lp(a) and coronary lesion burden was more pronounced at higher CTI levels, particular for MVD. Machine-learning analyses further supported the relevance of both CTI and Lp(a).
Conclusions: In patients with ACS, higher Lp(a) and CTI level were associated with greater angiographic coronary lesion burden. CTI may complement Lp(a) by capturing inflammatory-metabolic status, supporting their joint assessment for more refined characterization of lesion-burden risk in ACS.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 6 September 2026. Methods.