Association between lipoprotein(a) concentration and outcomes after percutaneous coronary intervention: A systematic review and meta-analysis - 04/07/25

Doi : 10.1016/j.acvd.2025.05.009

Gianmarco Cancelli ^a,^{^{1
These authors contributed equally.}}, Camilla S. Rossi ^a,^{^{1
These authors contributed equally.}}, Ovidio De Filippo ^b, Antonino Di Franco ^a, Lamia Harik ^a, Irene Borzillo ^b, Aina Hirofuji ^a, Giovanni Soletti ^a, Polina Mantaj ^a, Busra Cangut ^c, Talal Alzghari ^a, Michele Dell’Aquila ^a, Jordan Leith ^a, Mudathir Ibrahim ^d, Tulio Caldonazo ^a, Mohamed Rahouma ^a, Mario Gaudino ^a,⁎ , Fabrizio D’Ascenzo ^b
^a Department of Cardiothoracic Surgery, Weill Cornell Medicine, 10065 New York, USA
^b Division of Cardiology, Cardiovascular and Thoracic Department, “Citta della Salute e della Scienza” Hospital, 10162 Turin, Italy
^c Department of Cardiovascular Surgery, Mount Sinai Hospital, 10029 New York, USA
^d Department of General Surgery, Maimonides Medical Center, 11219 Brooklyn, France

^⁎Corresponding author. Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, 10065 New York, USA.Department of Cardiothoracic Surgery, Weill Cornell Medicine525 E 68th StNew York10065USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 04 July 2025

Résumé

Graphical abstract

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Highlights

•	Lp(a) is an important determinant of adverse cardiac outcomes in patients with ACS.
•	We compared outcomes after PCI in patients with high versus low Lp(a) concentration.
•	High Lp(a) was associated with higher rates of all-cause and cardiovascular deaths.
•	High Lp(a) was associated with higher rates of MI, MACE and stroke.
•	Future research: can Lp(a)-targeting therapies improve long-term outcome after PCI?

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Abstract

Background

Lipoprotein(a) is well known to be associated with the development of cardiovascular disease. Patients with an elevated baseline lipoprotein(a) concentration may be prone to unfavourable clinical outcomes following percutaneous coronary intervention.

Aim

We performed a study-level meta-analysis to evaluate differences in clinical outcomes after percutaneous coronary intervention in patients with high and low serum lipoprotein(a) concentrations.

Methods

A systematic literature search was conducted on Ovid MEDLINE, EMBASE and The Cochrane Library (Wiley) to identify studies reporting clinical outcomes in patients treated with percutaneous coronary intervention, stratified by preoperative lipoprotein(a) concentration. The lipoprotein(a) cut-off value of each individual study was considered for differentiation into low versus high lipoprotein(a) concentration groups. The primary outcome was all-cause death. Secondary outcomes were myocardial infarction, cardiovascular death, major adverse cardiovascular events and stroke.

Results

Fourteen studies (40,241 patients) were included. At a mean follow-up of 4.9 years, patients with high lipoprotein(a) concentrations had significantly increased rates of all-cause death (incidence rate ratio 1.42, 95% confidence interval 1.16–1.75; P<0.001), myocardial infarction (incidence rate ratio 1.45, 95% confidence interval 1.18–1.78; P<0.001), cardiovascular death (incidence rate ratio 1.50, 95% confidence interval 1.27–1.77; P<0.001), major adverse cardiovascular events (incidence rate ratio 1.35 95% confidence interval 1.19–1.54; P<0.001) and stroke (incidence rate ratio 1.33, 95% confidence interval 1.13–1.56; P<0.001) compared with patients with low lipoprotein(a) concentrations. Leave-one-out and cumulative analyses were consistent with the main analysis.

Conclusions

Among patients treated with percutaneous coronary intervention, high lipoprotein(a) concentrations are associated with higher rates of all-cause death, myocardial infarction, cardiovascular death, major adverse cardiovascular events and stroke compared with low lipoprotein(a) concentrations.

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Keywords : Lipoprotein(a), Percutaneous coronary intervention, Coronary artery disease