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

Abstract

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 ...

Lipoprotein(a), Interleukin‐10, C‐Reactive Protein, and 8‐Year Outcome After Percutaneous Coronary Intervention

“…Lp(a) is a lipoprotein that may induce either a prothrombotic/antifibrinolytic effect, as apolipoprotein(a) resembles plasminogen but has no fibrinolytic activity, or may accelerate atherosclerosis, because like low‐density lipoprotein, the Lp(a) particle is cholesterolrich, or both 14. Consequently, numerous studies have been performed on the role of Lp(a) in restenosis, rendering inconsistent results 15–21. Zairis et al investigated both in‐stent restenosis and incidence of MACE in 483 consecutive patients with either stable or unstable coronary syndromes undergoing PCI with stenting 22.…”

Is lipoprotein(a) a predictor for survival in patients with established coronary artery disease? Results from a prospective patient cohort study in northern Sweden

“…The importance of Lp(a) in secondary prevention has not been as thoroughly investigated. The association between Lp(a) and angiographically assessed progression of CAD [12, 13], restenosis after percutaneous transluminal coronary angioplasty (PTCA) [14‐18, 31,32] and CABG [19] have been investigated, but results have been inconclusive.…”

“…The influence of high Lp(a) levels on the progression of angiographically assessed CAD has been investigated, but results have been inconclusive [12‐19]. Angiography is an insensitive method assessing the extent of coronary atherosclerosis as segments of arteries, in which the lumen is normal in size, may still contain plaques [20].…”

Serum lipoprotein(a) level in relation to severity of coronary artery disease and coronary artery patency in acute myocardial infarction

“…16 Studies on the role of serum Lp(a) level as a risk factor for restenosis after percutaneous transluminal coronary angioplasty have yielded conflicting results. 17,18 The level of Lp(a) is higher in patients with MI not given thrombolytic therapy if the infarct-related artery is not recanalized spontaneously, 19 although no association between raised serum Lp(a) concentrations and unsuccessful thrombolysis has been observed. [20][21][22][23] However, the Lp(a) level is related to thrombin generation and spontaneous intermittent coronary occlusion in patients with acute MI.…”