Elevated Lp(a)-to-HDL-C ratio predicts repeat revascularization and in-stent restenosis after PCI in chronic coronary syndrome (Biomark Med 2026)

Original title: Lipoprotein(a)-to-HDL-C ratio and risk of repeat revascularization and in-stent restenosis after PCI in patients with chronic coronary syndrome undergoing follow-up coronary imaging

Biomark Med · 10 September 2026 · 6

Jiale W, Longcheng L, Peipei L, Lihong M

In a cohort of 2,238 patients with chronic coronary syndrome undergoing percutaneous coronary intervention, a novel Lp(a)-to-HDL-C ratio (LHR) was independently associated with repeat revascularization and in-stent restenosis over a median follow-up of 60 months. After multivariable adjustment, each unit increase in lnLHR yielded a hazard ratio of 1.08 (95% CI, 1.02-1.14), while patients in the highest tertile faced a 1.19-fold higher risk than those in the lowest (95% CI, 1.02-1.39). The LHR-based prediction model demonstrated modest discrimination with area under the curve values of 0.629 at 3 years and 0.648 at 5 years. These data position the Lp(a)-to-HDL-C ratio as a complementary marker for long-term risk stratification, though its clinical utility remains limited by modest predictive performance.

Original abstract

Background: We proposed a novel lipoprotein(a)-to-HDL-C ratio (LHR) and examined its association with repeat revascularization and in-stent restenosis (ISR) in patients with chronic coronary syndrome (CCS) after percutaneous coronary intervention (PCI).

Methods: A total of 2,238 patients with CCS undergoing DES-PCI who had available follow-up coronary imaging were included and categorized into tertiles according to lnLHR values. The primary outcome was a composite of repeat revascularization and ISR. Kaplan-Meier analysis, multivariable Cox regression, restricted cubic spline analysis, and prediction model evaluation were performed.

Results: During a median follow-up of 60 months, 1,031 patients (46.07%) experienced the primary endpoint. Higher lnLHR tertiles were associated with lower event-free survival (p = 0.002). After multivariable adjustment, lnLHR remained independently associated with the primary endpoint (HR, 1.08; 95% CI, 1.02-1.14; p = 0.009), and patients in the highest tertile had a higher risk than those in the lowest tertile (HR, 1.19; 95% CI, 1.02-1.39; p = 0.026). RCS analysis demonstrated a linear association between lnLHR and outcomes. The LHR-based model showed modest discrimination, with AUCs of 0.629 at 3 years and 0.648 at 5 years.

Conclusions: An elevated LHR was independently associated with an increased risk of repeat revascularization and ISR after PCI in CCS patients. These findings suggest that LHR may serve as a complementary lipid-related marker for long-term risk stratification in this population.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 11 September 2026. Methods.