ELEVATED LIPOPROTEIN(A) AND INCREASED INCIDENCE OF RESTENOSIS AFTER FEMOROPOPLITEAL PTA - RATIONALE FOR THE HIGHER RISK OF RECURRENCE IN FEMALES

It has been shown that the incidence of recurrent stenosis following s uccessful percutaneous transluminal coronary angioplasty (PTCA) is cor related with serum Lipoprotein(a) [Lp(a)] levels. The aim of the prese nt study was to examine the influence of Lp(a) on restenosis after pri marily successful femoropopliteal PTA. One hundred and thirty nine con secutive patients with peripheral arterial occlusive disease (PAOD) an d successful femoropopliteal PTA were studied. Follow-up included clin ical examination and non-invasive laboratory testing (pulse volume rec ordings, ankle-brachial arterial pressure measurement) in every patien t before and after 1, 3, 6 and 12 months following intervention. Duple x sonography was performed 1 year after PTA. Suspicion of restenosis ( greater than or equal to 50% diameter reduction) was verified by angio graphy. Lp(a) was determined using ELISA technique (mg/dl). Twelve mon ths after successful PTA no restenosis was found in 82 patients (59%: group A). The one-year recurrence rate of 41% (group B) was due to sig nificant restenosis in 35 patients (25%) and reocclusion in 22 patient s (16%). The corresponding mean values +/- S.E.M. for Lp(a) were as fo llows: group A, 28 +/- 5.3; group B, 59 +/- 11 (P < 0.01). Women showe d a higher frequency of recurrences (55%) versus men (30%, P < 0.01) a lso corresponding with a higher Lp(a) level (51.8 +/- 8 versus 32.7 +/ - 5; P < 0.05). Furthermore Lp(a) aggravated the well known increased risk for recurrence in multiple stenoses or occlusions of greater than or equal to 5 cm in length. There were no significant differences bet ween groups A and B with respect to age, diabetes, hyperlipidaemia, ob esity and cigarette smoking. The results support the view that Lp(a) i s an independent risk factor for recurrence after PTA in the femoropop liteal area. It might also be a causal basis for the higher incidence of recurrences in female PAOD patients.