Highlights
- •This study demonstrates a positive correlation between Lp(a) levels and coronary atherosclerotic burden in ACS patients.
- •Thin cap fibroatheroma are more frequent in patients with high Lp(a) levels.
- •The association of Lp(a) with cardiac events may ne accounted for by an increased atherosclerotic burden.
Abstract
Background
Lipoprotein Lp(a) has been shown to be an independent risk factor for coronary artery
disease (CAD). However, its association with CAD burden in patients with ACS is largely
unknown, as well as the association of Lp(a) with lipid rich plaques prone to rupture.
Aim
We aim at assessing CAD burden by coronary angiography and plaque features including
thin cap fibroatheroma (TCFA) by optical coherence tomography (OCT) in consecutive
patients presenting with acute coronary syndrome (ACS) and obstructive CAD along with
serum Lp(a) levels.
Methods
This study comprises an angiographic and an OCT cohort. A total of 500 ACS patients
(370 men, average age 66 ± 11) were enrolled for the angiographic cohort and 51 ACS
patients (29 males, average age 65 ± 11) were enrolled for the OCT cohort. Angiographic
CAD severity was assessed by Sullivan score and by Bogaty score including stenosis
score and extent index. OCT plaque features were evaluated at the site of the minimal
lumen area and along the culprit segment.
Results
In the angiographic cohort, at multivariate analysis, Lp(a) was a weak independent
predictor of Sullivan score (p < 0.0001), stenosis score (p < 0.0001) and extent index
(p < 0.0001). In the OCT cohort, patients with higher Lp(a) levels (≥30 md/dl) compared
to patients with lower Lp(a) levels (<30 md/dl) exhibited a higher prevalence of lipidic
plaque at the site of the culprit stenosis (67% vs. 27%; P = 0.02), a wider lipid
arc (135 ± 114 vs 59 ± 111; P = 0.03) and a higher prevalence of TCFA (38% vs. 10%;
P = 0.04).
Conclusions
Among patients with ACS, raised Lp(a) levels are associated with an increased atherosclerotic
burden and it identifies a subset of patients with features of high risk coronary
atherosclerosis.
Keywords
Abbreviation:
ACS (acute coronary syndromes), CAD (coronary artery disease), Framingham Risk Score (FRS), intravascular ultrasound (IVUS), Lp (lipoprotein), minimal luminal area (MLA), NSTEACS (non-ST-elevation acute coronary syndrome), Optical coherence tomography (OCT), Standard deviation (SD), ST-segment myocardial infarction (STEMI), thin-cap fibroatheroma (TCFA), troponin T (TnT)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 14, 2016
Accepted:
January 11,
2016
Received in revised form:
January 10,
2016
Received:
August 3,
2015
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
