BACKGROUND:Lipoprotein(a) [Lp(a)], which structurally resembles-tissue-type plasminogen, is reported to be associated with coronary atherosclerosis. We examined whether the acute change in Lp(a) by percutaneous transluminal coronary angioplasty (PTCA) is related to restenosis after PTCA.

METHODS AND RESULTS:We measured serum Lp(a) and other lipid parameters (triglycerides and total, LDL, and HDL cholesterol) before and 1 day after PTCA in 143 procedures and 3 days after and 4 months after PTCA in 62 procedures. Quantitative coronary angiography was performed, and restenosis was defined according to three criteria: (1) clinical recurrence of ischemic symptoms, (2) a final stenosis > 50%, and (3) an absolute decrease in minimal lumen diameter > 1/2 of the acute gain in the dilated segment. Restenosis was recognized in 25.9%, 35.7%, and 38.5% of the cases 4 months after PTCA for each criterion, respectively. Although triglyceride and LDL, HDL, and total cholesterol levels were similar in the restenosis and no-restenosis groups before PTCA, Lp(a) was significantly higher in the restenosis group. We found a significant reduction in Lp(a) in the restenosis but not the no-restenosis group 1 day after PTCA. At 3 days after and 4 months after PTCA, Lp(a) was similar in the two groups. A multivariate-analysis revealed that the absolute change in Lp(a) (before versus 1 day after PTCA) to be the sole significant predictor of restenosis among the clinical, angiographic, and plasma lipid parameters examined.

CONCLUSIONS:Lp(a) levels were significantly higher in the restenosis group, and they fell significantly after PTCA in the restenosis group.

译文

背景:脂蛋白(a)[Lp(a)]在结构上类似于组织型纤溶酶原,据报道与冠状动脉粥样硬化有关。我们检查了经皮腔内冠状动脉成形术(PTCA)引起的Lp(a)急性变化是否与PTCA后再狭窄有关。

方法和结果:我们测量了血清Lp(a)和其他脂质参数(甘油三酸酯和总胆固醇,LDL和HDL胆固醇)在143例手术中PTCA之前和之后1天,在62例手术中PTCA之后3天和之后4个月。进行了定量的冠状动脉造影,并根据三个标准定义了再狭窄:(1)缺血症状的临床复发,(2)最终狭窄> 50%,和(3)最小管腔直径绝对减小> 1/2扩张段的急性获益。对于每个标准,分别在PTCA后4个月的病例中分别发现了25.9%,35.7%和38.5%的再狭窄。尽管在PTCA之前在再狭窄和无再狭窄组中甘油三酯和LDL,HDL和总胆固醇水平相似,但再狭窄组中Lp(a)明显更高。我们发现PTCA后1天,再狭窄中Lp(a)显着降低,但未再狭窄组中Lp(a)却没有降低。在PTCA后3天和术后4个月,两组的Lp(a)相似。多变量分析显示,在检查的临床,血管造影和血浆脂质参数中,Lp(a)的绝对变化(PTCA之前与术后1天相比)是再狭窄的唯一重要预测指标。

结论:再狭窄组中Lp(a)的水平显着升高,而再狭窄组中PTCA后Lp(a)的水平显着下降。

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