Effect of Lp(a) on in-stent restenosis and non-target coronary lesions in CAD patients with drug-eluting stents / 解放军医学杂志

ABSTRACT

Objective To explore the effect of lipoprotein(a) [Lp(a)] on in-stent restenosis and non-target coronary lesions in coronary artery disease (CAD) patients implanted with drug-eluting stents. Methods One hundred and seventy-four patients, diagnosed as CAD and underwent percutaneous coronary intervention (PCI) with the implantation of drug-eluting stents (DES), were enrolled in present study; all of them were performed another elective PCI or revascularization within 1-4 years after their previous procedures. Thirty-one of enrolled patients were discovered to have in-stent restenosis. The relationship between Lp(a) and in-stent restenosis and the development of non-target coronary lesions were analyzed in groups stratified by the presence of in-stent stenosis or Lp(a) levels, and the independent risk factors of both in-stent restenosis and non-target lesions were also analyzed by multivariate logistic regression analysis. Results In CAD patients with DES, Lp(a) level in patients with in-stent restenosis showed a significant increase than those with the Lp(a) level non-restenosis [(437.57±391.60) mg vs. (279.46±288.06) mg, P=0.04]. In following analysis comparing lipid profiles and coronary angiography results between low and high Lp(a) groups, the percentage of triple-vessel disease and left main plus triple-vessel disease appeared to be statistically higher in high Lp(a) group than those in low Lp(a) group (P=0.022). Multivariate logistic regression analysis revealed that high level of Lp(a) and much number of stents implanted were the independent risk factors for in-stent restenosis of DES. In comparing the characteristics of coronary angiography and results of quantitative coronary angiography, number of cases with non-target lesions, presence of in-stent restenosis, minimal lumen diameter and in-stent late lumen loss were all significantly higher in high Lp(a) group than those in low Lp(a) group (P<0.05), and high level of Lp(a) was again proved to be an independent risk factor for non-target lesions in patients with DES (P=0.001). Conclusion Elevated Lp(a) level is an independent risk factor for both in-stent restenosis and the development of non-target coronary lesions, and is closely related to the relapse and aggravation of coronary artery disease.