Effectiveness of LDL-apheresis in preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA): LDL-apheresis angioplasty restenosis trial (L-ART).
To investigate the efficacy of reducing plasma lipoprotein(a) (Lp(a)) as well as low density lipoprotein cholesterol (LDL-C) levels on the prevention of restenosis after PTCA, LDL-apheresis was attempted on a total of 54 patients at six institutions. LDL-apheresis using a dextran sulfate cellulose column has been proven to be an effective method for reducing both plasma Lp(a) and LDL-C levels. As a subgroup (apheresis-drug combined group), 29 of the 54 patients were given Pravastatin (HMG CoA reductase inhibitor) and Niceritrol (Nicotinic Acid) in addition to LDL-apheresis to maintain low plasma levels of both Lp(a) and LDL-C through the follow-up period of 5 months after PTCA. Patients whose plasma Lp(a) levels were reduced by more than 50% showed a lower restenosis rate than those whose plasma Lp(a) levels were reduced by less than 50% (21.2% vs. 52.4%, P = 0.0179), especially in patients with high plasma Lp(a) levels above 30 mg/dl where a much lower restenosis rate (15.0%) was observed. Furthermore, in the apheresis-drug combined group, the restenosis rate was 11.8% regardless of baseline plasma Lp(a) levels, including even those below 30 mg/dl. In conclusion, in patients with high plasma Lp(a) levels, a greater than 50% reduction in Lp(a) levels by LDL-apheresis is effective in preventing restenosis after PTCA. If the plasma Lp(a) reduction rate is greater than 50%, LDL-apheresis combined with lipid-lowering drugs such as niceritrol and pravastatin seems to be more effective, even in patients with low plasma Lp(a) levels.
Yamaguchi
H
H
Department of Cardiology, Juntendo University, School of Medicine, Tokyo, Japan.
Lee
Y J
YJ
Daida
H
H
Yokoi
H
H
Miyano
H
H
Kanoh
T
T
Ishiwata
S
S
Kato
K
K
Nishikawa
H
H
Takatsu
F
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001781:Blood Component Removal / Q000379:methods*; D008078:Cholesterol, LDL / Q000097:blood / Q000302:isolation & purification; D003327:Coronary Disease / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D017270:Lipoprotein(a) / Q000097:blood / Q000302:isolation & purification; D008077:Lipoproteins, LDL / Q000097:blood* / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence
D008078:Cholesterol, LDL; D008055:Lipids; D017270:Lipoprotein(a); D008077:Lipoproteins, LDL