Elevated Serum Lipoprotein(a) Is a Risk Factor for Clinical Recurrence After Coronary Balloon Angioplasty

Desmarais, R.; Sarembock, Ian J.; Ayers, Carlos R.; Vernon, Sarah M.; Powers, Eric R.; Gimple, Lawrence W.

doi:10.1161/01.cir.91.5.1403

Cited by 116 publications

(43 citation statements)

References 45 publications

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“…Most of the previously published studies addressing the issue had methodological defects or constraints limiting the usefulness of the results. Various limitations of these studies included retrospective analysis 10,16 ; small sample size 9,11,14,15,18 ; inclusion of patients and measurement of Lp(a) within 4 weeks of acute myocardial infarction, 10,12 which increases Lp(a) for at least 4 weeks 21,23 ; blood sampling after PTCA 9,10,12,16 ; the interventional nature of the study 17 ; or assay of stored samples, 13 which can yield artifactually low levels of Lp(a).…”

Section: Discussionmentioning

confidence: 99%

“…The only study of comparable size to ours that showed a significant relation of Lp(a) level to risk of restenosis measured the Lp(a) level 4 weeks after angioplasty in 93 subjects who had a history of myocardial infarction within 1 month of PTCA from a total cohort of 240 subjects. 12 These Lp(a) measurements after PTCA may have confounded the analysis of Lp(a) as a predictor of risk for restenosis. Another study of comparable size, which has been reported in abstract form, found no significant correlation of Lp(a) with restenosis but was designed to test the effect of lipid lowering on restenosis.…”

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confidence: 99%

“…9,[12][13][14]28 Further indirect evidence that cholesterol levels are not predictive is the finding that a lack of family history of premature coronary artery disease was predictive of restenosis (Pϭ0.008); such a family history would be likely in patients with elevated serum cholesterol because of familial hypercholesterolemia. We also analyzed the effect of procedural variables.…”

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confidence: 99%

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Lipoprotein(a) Level Does Not Predict Restenosis After Percutaneous Transluminal Coronary Angioplasty

Alaigh

Hoffman

Korlipara

et al. 1998

ATVB

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Abstract-The serum lipoprotein(a) [Lp(a)] level is a known risk factor for arteriosclerotic coronary artery disease.However, its association with restenosis after percutaneous transluminal coronary angioplasty (PTCA) is controversial. We hypothesized that the Lp(a) level is a significant risk factor for restenosis after angioplasty through a pathophysiological mechanism leading to excess thrombin generation or inhibition of fibrinolysis. We designed a prospective study of the relation of Lp(a) to outcome after PTCA, in which we measured selected laboratory variables at entry and collected clinical, procedural, lesion-related, and outcome data pertaining to restenosis. Restenosis was defined as Ͼ50% stenosis of the target lesion by angiography or as ischemia in the target vessel distribution by radionuclide-perfusion scan. Before the patients underwent PTCA, blood was obtained by venipuncture for measurement of Lp(a), total cholesterol, thrombin-antithrombin (TAT) complex, ␣ 2 -antiplasmin-plasmin (APP) complex, and plasminogen activator inhibitor-1 (PAI-1). Evaluable outcome data were obtained on 162 subjects, who form the basis of this report. Restenosis occurred in 61 subjects (38%). The Lp(a) level was not correlated significantly with TAT, APP, PAI-1, or the TAT-APP ratio. Levels of TAT, APP, and PAI-1 were not statistically different in the patients with versus those without restenosis. The median ratio of TAT to APP was 2-fold higher in the restenosis group, and this difference approached statistical significance (Pϭ0.07). Univariate analysis was performed for the association of clinical, lesion-related, and procedural risk factors with restenosis. Lp(a) levels did not differ significantly in the restenosis versus no-restenosis group, whether assessed categorically (Ͼ25 mg/dL versus Ͻ25 mg/dL) or as a continuous variable by Mann-Whitney U test. The number of lesions dilated and the lack of family history of premature heart disease were significantly associated with restenosis (Pϭ0.002 and Pϭ0.008, respectively). A history of diabetes mellitus was of borderline significance (Pϭ0.055). By multiple logistic regression analysis, the number of lesions dilated was the only variable significantly associated with restenosis (Pϭ0.03). We conclude that the number of lesions dilated during PTCA is a significant risk factor for restenosis, whereas the serum Lp(a) level was not a significant risk factor for restenosis in our patient population. The TAT to APP ratio merits further study as a possible risk factor for restenosis. (Arterioscler Thromb Vasc Biol. 1998;18:1281-1286.)Key Words: lipoprotein(a) Ⅲ angioplasty Ⅲ thrombin Ⅲ plasmin Ⅲ antiplasmin P ercutaneous transluminal coronary angioplasty (PTCA) has become a standard procedure for the treatment of coronary artery disease. However, in spite of advances in techniques, restenosis after PTCA remains a common complication, at a rate of 30% to 40% in the absence of stent placement.1-4 Various risk factors predictive of restenosis have been identified, and these can ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Lipoprotein(a) Level Does Not Predict Restenosis After Percutaneous Transluminal Coronary Angioplasty

Alaigh

Hoffman

Korlipara

et al. 1998

ATVB

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“…[6][7][8] Percutaneous transluminal coronary angioplasty (PTCA) with or without stent implantation is an established revascularization procedure; however, restenosis rates still range between 30-60% 6 and 15-30%, 7 respectively Preprocedural identification of low-and high-risk patients who might benefit from additional procedures 6,8 would be desirable. However, the predictors of early [7][8][9][10] and late complications [11][12][13][14][15] have a low predictive value, [15][16][17][18] are available only after procedures, 9,14 or are not easily applicable in clinical practice. 10,12,13 Inconsistent and weak correlation with early complications following PTCA was reported for female gender, extreme age, diabetes, multivessel disease, lesion characteristics, and hemostatic variables.…”

Section: Introductionmentioning

confidence: 99%

“…10,12,13 Inconsistent and weak correlation with early complications following PTCA was reported for female gender, extreme age, diabetes, multivessel disease, lesion characteristics, and hemostatic variables. [6][7][8][9][10][11][12][13][14][15][16][17][18] This study was therefore undertaken to investigate the short-and long-term prognostic value of preprocedural serum levels of CRP in patients with AMI receiving PTCA/stenting.…”

Section: Introductionmentioning

confidence: 99%

The relation between preprocedural C‐reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty

Magadle

Hertz²,

Merlon³

et al. 2004

Clinical Cardiology

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SummaryBackground: Inflammation is an important feature of arteriosclerotic disease, and the vulnerability of coronary plaques in acute myocardial infarction (AMI) may be related to the levels of serum C-reactive proteins (CRP). While some risk factors for early and late complications have been suggested, an accurate and definitive preprocedural risk stratification of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) is still lacking.Hypothesis: The study was undertaken to investigate whether early and late complications after PTCA could be predicted by evaluation of baseline serum CRP levels in patients with AMI.Methods: Levels of serum CRP were measured in a total of 230 patients with AMI undergoing PTCA and provisional stent. They were divided into two groups: Group 1 (n = 48) with elevated CRP levels (≥ 5 mg/l) and Group 2 (n = 182) with normal CRP levels (< 5 mg/l).Results: There were no significant differences in baseline clinical, angiographic, and procedural characteristics between the two groups. However, the incidence of in-hospital adverse coronary events (reinfarction, coronary reocclusion, target vessel revascularization, and death) and severe left ventricular dysfunction was significantly higher in Group 1 (18.3 vs. 6.1%,

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Lipoprotein Lp(a) Excess and Coronary Heart Disease

Stein

Rosenson²

1997

Arch Intern Med

147

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Lipoprotein Lp(a) excess has been identified as a powerful predictor of premature atherosclerotic vascular disease in several large, prospective studies. Lipoprotein Lp(a) levels modulate the risk of coronary heart disease in patients with hypercholesterolemia, and lipoprotein Lp(a) excess is commonly detected in men and women with premature coronary atherosclerosis. Lipoprotein Lp(a) contributes to atherothrombotic risk by multiple mechanisms that include impaired fibrinolysis, increased cholesterol deposition in the arterial wall, and enhanced oxidation of low density lipoprotein cholesterol. Although low density lipoprotein cholesterol reduction is the primary intervention in patients with lipoprotein Lp(a) excess, specific therapy to lower lipoprotein Lp(a) may be indicated for patients with premature coronary atherosclerosis, a strong family history of premature atherosclerosis, or refractory hypercholesterolemia. In consideration of the high prevalence of lipoprotein Lp(a) excess in patients with premature coronary heart disease and the intricate role of lipoprotein Lp(a) in atherothrombosis, this review provides an evidence-based approach to the screening and treatment of patients with lipoprotein Lp(a) excess.

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Elevated Serum Lipoprotein(a) Is a Risk Factor for Clinical Recurrence After Coronary Balloon Angioplasty

Cited by 116 publications

References 45 publications

Lipoprotein(a) Level Does Not Predict Restenosis After Percutaneous Transluminal Coronary Angioplasty

Lipoprotein(a) Level Does Not Predict Restenosis After Percutaneous Transluminal Coronary Angioplasty

The relation between preprocedural C‐reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty

Lipoprotein Lp(a) Excess and Coronary Heart Disease

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