The Effect of Lipoprotein(a) Levels on Non-Culprit Atherosclerosis in Patients With Acute Coronary Syndrome Who Underwent Percutaneous Coronary Intervention: An Optical Coherence Tomography Study
Yi-fei Wang, Tian Xu, and Wei You are contributed equally to this study.
ABSTRACT
Background
The association between lipoprotein(a) [Lp(a)] levels and progression of non-culprit atherosclerosis (NSA) in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is unknown.
Methods
This study enrolled 177 patients with ACS who underwent OCT-guided PCI and follow-up OCT examinations of non-culprit lesions between 2013 and 2018. Lesion characteristics including fibrous tissue, calcium, lipid, and macrophage content were assessed using quantitative plaque analysis. High Lp(a) levels were defined as Lp(a) ≥ 30 mg/dL. The association between Lp(a) levels and NSA progression was investigated using linear effect models adjusted for clinical risk factors. A discordance analysis was also performed.
Results
At 1-year follow-up, individuals with Lp(a) levels ≥ 30 mg/dL had increased total atheroma volume and lipid component, and higher incidence of thin-cap fibroatheroma (TCFA) (p = 0.021; p = 0.006; p = 0.025, respectively). After adjusted, multivariable linear regression model revealed an association between Lp(a) and plaque progression in NSA (7.22 for each 1 SD increase, 95% CI: 0.96–13.48; p = 0.025) and increased lipid component (3.60 for each 1 SD increase, 95% CI: 0.63–6.56; p = 0.019). Discordance analyses showed that individuals with discordantly low Lp(a) levels had the lightest plaque progression and increase in lipid plaque burden (17.34 [10.22, 28.21] vs. 28.73 [14.88, 45.88] versus 25.73 [13.85, 45.70], p = 0.017).
Conclusion
Among patients with ACS, elevated Lp(a) levels were related to the progression of coronary plaques in non-culprit lesions, including increased total atheroma volume and lipid component, and a higher prevalence of TCFA at follow-up.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
