High serum concentration of lipoprotein(a) is a risk factor for restenosis after percutaneous transluminal coronary angioplasty in Japanese patients with single-vessel disease

Miyata, Masaaki; Biro, Sadatoshi; Arima, Shinichi; Hamasaki, Shuichi; Kaieda, Hiroshi; Nakao, Shoichiro; Kawataki, Masamitsu; Nomoto, Kunihiro; Tanaka, Hiromitsu

doi:10.1016/s0002-8703(96)90421-4

Cited by 28 publications

(15 citation statements)

References 29 publications

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“…5,10,12, 13 Violaris et al 27 reported no association between total cholesterol and restenosis in a prospective study involving quantitative angiographic analysis of 3336 lesions, in agreement with our data and those of other investigators. 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.…”

supporting

confidence: 90%

“…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%

“…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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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

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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 Many recent studies have demonstrated associations of high serum Lp(a) level with restenosis after percutaneous coronary intervention (PCI) [7][8][9][10][11] and with restenosis of the coronary bypass graft. 12 On the other hand, it has been reported that serum Lp(a) level does not influence restenosis after elective coronary stenting.…”

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Serum Lipoprotein(a) Level and Clinical Coronary Stenosis Progression in Patients With Myocardial Infarction Re-Revascularization Rate is High in Patients With High-Lp(a)

Morita

Himeno

Yakuwa

et al. 2006

Circ J

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Lp(a) level, the patients were classified into either a highLp(a) (serum Lp(a) level ≥30 mg/dl) or a low-Lp(a) (serum Lp(a) level <30 mg/dl) group for evaluation of the clinical coronary stenosis progression (CCSP) between the 2 groups. Because a serum Lp(a) level of 31 mg/dl was the 75 th percentile of this study population, we defined patients with a serum Lp(a) level ≥30 mg/dl as the high-Lp(a) group. We also evaluated hypertension (systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg or receiv- Background High serum lipoprotein(a) (Lp(a)) levels are associated with coronary artery disease. Methods and ResultsThe serum Lp(a) levels of 130 patients with acute myocardial infarction (AMI) who underwent direct percutaneous coronary intervention were investigated. On the basis of Lp(a) level at 1 month after the onset of AMI, the patients were classified into 2 groups (high-Lp(a) (≥30 mg/dl) and low-Lp(a) (<30 mg/dl)) for evaluation of the clinical coronary stenosis progression (CCSP) rate. CCSP is defined as either target lesion revascularization (TLR) or new lesion revascularization (NLR). The CCSP rate was significantly higher in the high-Lp(a) group than in the low-Lp(a) group (65.8% vs 29.3%, p<0.01). In patients who had coronary stents in the acute phase (n=79), the CCSP and NLR rates were significantly higher in the high-Lp(a) group than in the low-Lp(a) group (45.0% vs 20.3%, p<0.05; 35.0% vs 6.8%, p<0.01), but there was no significant difference in TLR rate between the 2 groups (10.0% vs 13.6%, p=0.858).Conclusions High serum Lp(a) level is a significant risk factor for CCSP, but does not influence restenosis after stenting. (Circ J 2006; 70: 156 -162)

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“…6,7 Although elevated plasma concentrations of Lp(a) are considered an independent risk factor for CAD, 8,9 myocardial infarction, 10,11 cerebrovascular disease, 12 peripheral vascular disease, 13 venous thrombembolism 14 and vein graft stenosis after coronary artery surgery, 15 the association between plasma Lp(a) concentration and restenosis after PCI is still controversial. Some reports suggest the influence of elevated Lp(a) concentrations on restenosis after balloon angioplasty, [16][17][18] but others do not. 19,20 A recent study reported that plasma Lp(a) concentration is not a predictor of restenosis after stent implantation, 21 but a histological study has demonstrated that the formation of arterial plaque correlates well with high plasma concentrations of Lp(a).…”

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Association Between Plasma Lipoprotein(a) Concentration and Restenosis After Stent Implantation

Kamitani

Taniguchi

Miyai

et al. 2005

Circ J

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Background The plasma concentration of lipoprotein (a) [Lp(a)] is associated with atherosclerotic and thrombotic vascular diseases. The aim of the present study was to evaluate the association between plasma Lp(a) concentration and in-stent restenosis. Methods and ResultsOne hundred and 9 patients with successful elective coronary stent implantation underwent follow-up angiography at 24±6 weeks. Restenosis after stent implantation occurred in 38 patients. Univariate analysis showed that the reference diameter of the lesion was smaller in the restenosis group (2.93±0.29 mm) than in the no-restenosis group (3.21±0.43 mm) (p<0.05). The lesion was longer in the restenosis group (14.2± 5.3 mm) than in the no-restenosis group (11.6±4.9 mm) (p<0.05). Plasma Lp(a) concentrations in the restenosis group (30.5±23.9 mg/dl) were higher than in the no-restenosis group (16.9±11.1 mg/dl) (p<0.01). Other lipid concentrations were similar in both groups. Among the plasma Lp(a) concentrations, the rate of restenosis (71.4%) in the high Lp(a) group (>40 mg/dl) (n=14) was greater compared with the other groups: 33.3% in the intermediate Lp(a) group (10-40 mg/dl) (n=54), and 24.4% in the low Lp(a) group (<10 mg/dl) (n=41) (p<0.01). The late loss (0.57±0.53 mm) in the low Lp(a) group was significantly less than the other groups: 0.88±0.47 mm in the intermediate Lp(a) group, and 1.08±0.56 mm in the high Lp(a) group (p<0.05). In a multivariate regression model, plasma Lp(a) concentration remained significant as an independent predictor of restenosis in patients undergoing stent implantation (p=0.020 odds ratio (OR) 1.37 95%conficence interval (CI) 1.050-1.793), although the reference diameter (p=0.025 OR 0.23 95%CI 0.061-0.830) and lesion length (p=0.021 OR 1.12 95%CI 1.017-1.232) were related to stent restenosis. Conclusions Plasma Lp(a) concentration is an independent predictor of stent restenosis. (Circ J 2005; 69: 644 -649)

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High serum concentration of lipoprotein(a) is a risk factor for restenosis after percutaneous transluminal coronary angioplasty in Japanese patients with single-vessel disease

Cited by 28 publications

References 29 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

Serum Lipoprotein(a) Level and Clinical Coronary Stenosis Progression in Patients With Myocardial Infarction Re-Revascularization Rate is High in Patients With High-Lp(a)

Association Between Plasma Lipoprotein(a) Concentration and Restenosis After Stent Implantation

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