Association between plasma lipoprotein(a) concentration and restenosis after stent implantation.

BACKGROUND: The plasma concentration of lipoprotein (a) Lp(a)] is associated with atherosclerotic and thrombotic vascular diseases. The aim of the present study was to evaluate the association between plasma Lp(a) concentration and in-stent restenosis. METHODS AND RESULTS: One hundred and 9 patients with successful elective coronary stent implantation underwent follow-up angiography at 24+/-6 weeks. Restenosis after stent implantation occurred in 38 patients. Univariate analysis showed that the reference diameter of the lesion was smaller in the restenosis group (2.93+/-0.29 mm) than in the no-restenosis group (3.21+/-0.43 mm) (p < 0.05). The lesion was longer in the restenosis group (14.2+/-5.3 mm) than in the no-restenosis group (11.6+/-4.9 mm) (p < 0.05). Plasma Lp(a) concentrations in the restenosis group (30.5+/-23.9 mg/dl) were higher than in the no-restenosis group (16.9+/-11.1 mg/dl) (p < 0.01). Other lipid concentrations were similar in both groups. Among the plasma Lp(a) concentrations, the rate of restenosis (71.4%) in the high Lp(a) group (> 40 mg/dl) (n = 14) was greater compared with the other groups: 33.3% in the intermediate Lp(a) group (10-40 mg/dl) (n = 54), and 24.4% in the low Lp(a) group (< 10 mg/dl) (n = 41) (p < 0.01). The late loss (0.57+/-0.53 mm) in the low Lp(a) group was significantly less than the other groups: 0.88+/-0.47 mm in the intermediate Lp(a) group, and 1.08+/-0.56 mm in the high Lp(a) group (p < 0.05). In a multivariate regression model, plasma Lp(a) concentration remained significant as an independent predictor of restenosis in patients undergoing stent implantation (p = 0.020 odds ratio (OR) 1.37 95%conficence interval (CI) 1.050-1.793), although the reference diameter (p = 0.025 OR 0.23 95%CI 0.061-0.830) and lesion length (p = 0.021 OR 1.12 95%CI 1.017-1.232) were related to stent restenosis. CONCLUSIONS: Plasma Lp(a) concentration is an independent predictor of stent restenosis.