Can lipoprotein(a) predict the need for coronary artery revascularization in a chronic setting?
D Besic, M Vidjak, M Spoljaric, K Gjuras, F Saler, A Serman, M Krizanovic, J Catic, S Manola, I JurinAbstract
Background
According to current guidelines for the care of chronic coronary syndromes (CCS), referral for invasive coronary angiography (CA) should be guided by a diagnostic approach based on clinical probability and non-invasive tests, without taking into account circulating biomarkers in this decision-making process. [1] Lipoprotein(a), or Lp(a), a well-known biomarker for atherosclerosis, is linked to a more severe presentation of coronary artery disease (CAD), yet its role in guiding invasive diagnostic evaluation in the chronic setting remains undefined. [2]
Objectives
The aim of the study was to examine the association of Lp(a) levels and significant CAD requiring coronary revascularization in a chronic setting.
Methods
The study included patients from the prospective CaRD registry who underwent CA at our facility between November 2019 and February 2026 and who had either an established or suspected CCS diagnosis (based on clinical presentation, available laboratory, and non-invasive test results). Logistic regression analysis was used to investigate the relationship between Lp(a) levels and the requirement for coronary revascularization (either percutaneous or surgical). Additionally, via Mann-Whitney test and χ2-squared test we compared baseline patients' characteristics, including age, sex, creatinine, low-density lipoprotein (LDL), Lp(a) levels, Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) I score, prior known CAD, hypertension, dyslipidaemia, prediabetes/diabetes and smoking history, between the group that received conservative treatment and the group that underwent subsequent revascularization. A p-value of 0.05 was regarded as statistically significant. Statistical analysis was conducted in MedCalc Statistical Software version 14.8.1, Ostend, Belgium.
Results
Our observational registry-based study included 1315 patients with a median age of 68 years (IQR 61-74). Baseline characteristics of patients included in the study are displayed in Table 1. A total of 309 patients (23.5%) required revascularization based on angiographic findings. Logistic regression analysis demonstrated a positive association between higher Lp(a) levels and the subsequent coronary revascularization, p = .0009 (Figure 1). The positive link for Lp(a) levels remained significant after multiple regression analysis adjusted for age, sex, LDL, prior known CAD, hypertension, dyslipidaemia, prediabetes/diabetes and smoking history (p = .0014), and the model as a whole was significant (p<.0001).
Conclusion
In this observational cohort, higher Lp(a) concentrations were associated with subsequent coronary revascularization, suggesting a possible role in refining risk assessment in CCS. Before Lp(a) is taken into consideration for incorporation into clinical decision-making algorithms, these exploratory findings need to be prospectively validated.