CLINICAL STUDIES
Lipoprotein(a) and coronary thrombosis and restenosis after stent placement
Anne Wehinger, MD*,
Adnan Kastrati, MD*,
Shpend Elezi, MD*,
Hannsjörg Baum, MD ,
Siegmund Braun, MD*,
Franz-Josef Neumann, MD* and
Albert Schömig, MD*
* Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany
Institut für Klinische Chemie und Pathochemie, Technische Universität München, Munich, Germany
Manuscript received August 5, 1998;
revised manuscript received October 20, 1998,
accepted December 11, 1998.
Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum, Lazarettstr. 36, 80636 München, Germany
kastrati{at}dhm.mhn.de
OBJECTIVES
The objective of this prospective study was to evaluate the relation between high lipoprotein(a) levels and thrombotic and restenotic events after coronary stent implantation.
BACKGROUND
Lipoprotein(a) may promote atherogenesis, coronary thrombosis and restenosis after balloon angioplasty, but the clinical significance remains unclear.
METHODS
The study included 2,223 consecutive patients with successful coronary stent placement. According to the serum level of lipoprotein(a), patients were divided in two groups: 457 patients of the highest quintile formed the high lipoprotein(a) group, and 1,766 patients of the lower four quintiles formed the low lipoprotein(a) group. Primary end points were the incidence of angiographic restenosis at six months and the event-free survival at one year. Secondary end point was the incidence of angiographic stent occlusion.
RESULTS
Early stent occlusion occurred in four of the 457 patients (0.9%) with high and 37 of the 1,766 patients (2.1%) with low lipoprotein(a) levels, odds ratio of 0.41 (95% confidence interval, 0.15 to 1.16). Angiographic restenosis occurred in 173 of the 523 lesions (33.2%) in the high lipoprotein(a) group and 636 of the 1,943 lesions (32.7%) in the low lipoprotein(a) group, odds ratio of 1.02 (0.83 to 1.25). The probability of event-free survival was 73.0% in the high lipoprotein(a) group and 74.8% in the low lipoprotein(a) group (p = 0.45). On the basis of the findings in the low lipoprotein(a) group, the power of this study to detect a 25% increase in the incidence of restenosis and adverse events in the group with elevated lipoprotein(a) was 90% and 75%, respectively.
CONCLUSIONS
Elevated lipoprotein(a) levels did not influence the one-year clinical and angiographic outcome after stent placement. Thrombotic events and measures of restenosis were not adversely affected by the presence of high lipoprotein(a) levels.
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Abbreviations and Acronyms
| | apo(a) | = apolipoprotein(a) | | LDL | = low density lipoprotein | | Lp(a) | = lipoprotein(a) | | MLD | = minimal lumen diameter | | RD | = reference diameter | | TGF-beta | = transforming growth factor-beta |
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