ASSOCIATION OF AN ACUTE REDUCTION IN LIPOPROTEIN(A) WITH CORONARY-ARTERY RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background Lipoprotein(a) [Lp(a)]. which structurally resembles tissue -type plasminogen. is reported to be associated with coronary atherosc lerosis. We examined whether the acute change in Lp(a) by percutaneous transluminal coronary angioplasty (PTCA) is related to restenosis aft er PTCA. Methods and Results We measured serum Lp(a) and other lipid p arameters (triglycerides and total, LDL. and HDL cholesterol, before a nd 1 day after PTCA in 143 procedures and 3 days after and 4 months af ter PTCA in 62 procedures. Quantitative coronary angiography was perfo rmed, and restenosis was defined according to three criteria: !ii clin ical recurrence of ischemic symptoms. (2) a final stenosis >50%, and ( 3) an absolute decrease in minimal lumen diameter > 1/2 Of the acute g ain 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, respec tively. Although triglyceride and LDL, HDL, and total cholesterol leve ls were similar in the restenosis and no-restenosis groups before PTCA , Lp(a, war significantly higher in the restenosis group. We found a s ignificant reduction in Lp(a) in the restenosis but not the no-resteno sis group I day after PTCA, At 3 days after and 4 months after PTCA, L p(a) was similar in the two groups. A multivariate analysis revealed t hat the absolute change in Lp(a) (before versus I day after PTCA) to b e the sole significant predictor of restenosis among the clinical. ang iographic. and plasma lipid parameters examined. Conclusions Lp(a) lev els were significantly higher in the restenosis group. and they fell s ignificantly after PTCA in the restenosis group.