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Title:Association of Elevated Lipoprotein(a) Levels with Adverse Outcomes in Patients with Stable Angina Undergoing Stent-less PCI with Paclitaxel-coated Balloon

Tomonori Takahashi, MD, PhD1, Tetsuzo Wakatsuki, MD, PhD1, Ryo Bando, MD1, Yoshihito Saijo, MD, PhD1, Yutaka Kawabata, MD, PhD1, Rie Ueno, MD1, Tomomi Matsuura, MD, PhD1, Takayuki Ise, MD, PhD1, Koji Yamaguchi, MD, PhD1, Shusuke Yagi, MD, PhD2, Hirotsugu Yamada, MD, PhD3, Takeshi Soeki MD, PhD1, Masataka Sata, MD, PhD1.

1Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan

2Department of Community and Family Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

3Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

[Background] Evidence on the long-term prognosis of stent-less percutaneous coronary intervention (PCI) using paclitaxel-coated balloons (PBCs) is becoming established, however some prognostic indicators remain unexplored. Recently, elevated blood lipoprotein(a) levels are gaining attention as an independent risk factor for the development of atherosclerosis. We hypothesized that elevated lipoprotein(a) levels would also adversely affect the outcome of stent-less PCI.

[Object] The aim of this study is to investigate the association between lipoprotein(a) levels and outcomes after stent-less PCI.

[Methods] In this single-center retrospective study, patients with stable angina undergoing stent-less PCI with PCBs in de novo lesions at our institution were included between October 2016 and September 2022. We classified all patients into three groups according to lipoprotein(a) tertiles and performed a Cox proportional hazards analysis. The primary endpoint was a composite outcome of cardiovascular death, major bleeding, myocardial infarction, and target lesion revascularization.

[Results] A total of 207 patients were included, including a mean age of 70±11 years and 75% male. The median lipoprotein(a) level was 12.4 nmol/L (IQR 4.8-21.4 nmol/L). During a median follow-up of 18 months, the composite outcome was observed in 37 patients (17.9%). Patients with the highest lipoprotein(a) group (≧18.4 nmol/L) had a 4-fold higher risk than those with the lowest group (<7.1 nmol/L) (adjusted hazard ratio: 3.98[1.46-10.83],p=0.02).

[Conclusions] Patients with high lipoprotein(a) levels may have an unfavorable outcome compared to those with low levels undergoing stent-less PCI with PCBs.