Abstract 4363863: Does Lipoprotein(a) Associate with In-Stent Neoatherosclerosis and Plaque Vulnerability Detected by Optical Coherence Tomography in Patients with Acute Coronary Syndrome?
Abstract
Background: Recently, lipoprotein(a) [Lp(a)], a genetically determined low-density lipoprotein-like particle, has been recognized as a potential therapeutic target for residual cardiovascular risk. In-stent restenosis remains one of major clinical challenges for patients undergoing stent implantation. This study aimed to investigate the association between Lp(a) level and optical coherence tomography (OCT)-defined ISNA as well as plaque vulnerability in patients with acute coronary syndrome (ACS). Methods: From January 2017 to December 2021, 146 ACS patients with ISR undergoing OCT-guided intervention were enrolled. Baseline serum Lp(a) levels were measured via latex particle-enhanced turbidimetric immunoassay (Roche Diagnostics) and categorized into high (≥75 nmol/L, n=34) and low (<75 nmol/L, n=112) groups. Clinical profiles, angiographic features, and OCT data were compared between groups. Multivariate logistic regression adjusted for covariates was performed to identify independent associations. The primary endpoint was the presence of in-stent neoatherosclerosis (ISNA). Results: The cohort had a mean age of 62.3±8.9 years, with 73.3% (107/146) males. Elevated Lp(a) (≥75 nmol/L) was observed in 23.3% (34/146) of patients. Compared to the low Lp(a) group, the high Lp(a) group exhibited significantly higher rates of ISNA (91.2% vs. 50.9%, P<0.001), thin-cap fibroatheroma (TCFA) (38.2% vs. 8.0%, P<0.001), macrophage accumulation (82.4% vs. 64.3%, P=0.047). Conversely, homogeneous neointima was more prevalent in the low Lp(a) group (41.1% vs. 4.2%, P<0.001). Multivariate analysis confirmed that elevated Lp(a) independently correlated with ISNA (OR: 1.012, 95% CI: 1.004–1.020; P=0.002) and TCFA (OR: 1.010, 95% CI: 1.005–1.016; P<0.001). Conclusion: In ACS patients with ISR, Lp(a) ≥75 nmol/L is independently associated with increased risks of ISNA and vulnerable plaque phenotypes. These findings highlight the potential role of Lp(a) in ISR pathogenesis and suggest its utility in risk stratification and targeted therapeutic strategies.
Article Details
Authors (17)
Jiawen Chen
State Key Laboratory of Magnetic Resonance Spectroscopy and Imaging, National Center for Magnetic Resonance in Wuhan, Wuhan National Laboratory for Optoelectronics, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology
Shengen Gao
Harbin Medical University, 2nd hosp, Harbin, China
fuhong dong
Harbin Medical University, 2nd hosp, Harbin, China
Dongxu Huang
Harbin Medical University, 2nd hosp, Harbin, China
Lina Cui
xianqin ma
Harbin Medical University, 2nd hosp, Harbin, China
Jiawei Zhao
State Key Laboratory of Physical Chemistry of Solid Surfaces, iChEM, College of Chemistry and Chemical Engineering, Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen University, Xiamen 361005, China
Yuzhu Chen
Key Laboratory of Automobile Materials MOE, School of Materials Science & Engineering, Electron Microscopy Center, International Center of Future Science, Changbaishan Laboratory Jilin University Changchun 130012 China
Rui Zhao
yishuo xu
Harbin Medical University, 2nd hosp, Harbin, China
Lulu Li
Institute of Chemical Research of Catalonia (ICIQ-CERCA)
Yini Wang
Xing Xu
Ting Chen
Jiannan Dai
Chao Fang
State Key Laboratory of Physical Chemistry of Solid Surfaces, College of Chemistry and Chemical Engineering & Institute of Artificial Intelligence & Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM)
Bo Yu