The Association Of Lipoprotein (A) With Coronary Artery Calcification Patterns Detected By Intravascular Ultrasound (IVUS) In Ischemic Patients Presented For PCI

Abstract

Background: Coronary artery disease (CAD), driven by atherosclerosis and risk factors like hypertension, diabetes, and hyperlipidemia, is a major global health burden, particularly in low- and middle-income countries. Coronary artery calcification (CAC), a regulated process linked to atherosclerosis, is prevalent in CAD patients, complicating percutaneous coronary intervention (PCI). Techniques such as balloon angioplasty, rotational atherectomy, and stenting are tailored to plaque calcification. Intravascular ultrasound (IVUS) is highly accurate in detecting CAC. Elevated lipoprotein (a) (Lp(a)), associated with residual risk of cardiovascular disease, has an unclear role in CAC and its impact on PCI.[1-3]

Objective: To determine the relation between serum lipoprotein (a) levels and coronary plaque calcification burden detected by intravascular ultrasound (IVUS) in ischemic patients undergoing PCI procedures.

Patients and Methods: 90 patients with ischemic heart disease presented for percutaneous coronary interventions. IVUS was used for assessment of plaque morphology and calcifications. Serum LP(a) was measured to all eligible patients.

Results: The study demonstrated a positive correlation between LP(a) level and measures of calcium assessment including angiographic calcium and IVUS detected calcium. LP(a) level was higher in patient with higher calcium arc and calcium length by IVUS. Higher LP(a) was associated with more mixed calcium sites (superficial and deep). After diving the study population into 2 groups depending on the LP(a) level (below or above 50 mg/dl), patient with higher LP(a) > 50 mg have higher calcification burden by IVUS (calcium length, calcium arc, mixed calcium sites). LP(a) was associated with lower minimal luminal area (MLA) and higher plaque burden.

Conclusion: high LP(a) levels is associated with more coronary plaque calcification burden by IVUS with possible need for calcium modification strategies during PCI.