Restenosis after intracoronary stent placement: can apolipoprotein(a) polymorphism play a role?
BACKGROUND
The relationship between lipoprotein(a) and restenosis after intracoronary stent implantation has been analysed by two specific studies, but the role of apoliprotein(a) polymorphism was not considered. The aim of the present prospective study was to evaluate whether lipoprotein(a) levels and apolipoprotein(a) phenotypes are predictors of restenosis after elective stent implantation in patients with de novo lesions of coronary arteries.


METHODS
We recruited 182 patients with a new lesion successfully treated with elective placement of one or two Palmaz-Schatz stents. Follow-up angiography was scheduled at 6 months or earlier if clinically indicated. Nine patients were lost to the follow up. Among 173 patients enrolled, restenosis was present in 52 (30.0%) and absent in 121 (70.0%).


RESULTS
Lipoprotein(a) levels were higher in the restenosis than in the nonrestenosis group (29.5+/-17.2 versus 27.4+/-20.2 mg/dl), even if the difference did not attain statistical significance (P=0.067). The restenosis group had a percentage of subjects with at least one apolipoprotein(a) isoform of low molecular weight significantly greater than the nonrestenosis group (82.7 versus 66.9%; P=0.035). A multiple logistic regression analysis showed that multiple stenting (RR: 4.01; CI 95%: 1.65-13.91; P=0.004), presence of diabetes (RR: 3.96; CI 95%: 1.67-9.37; P=0.002) and presence of multivessel disease (RR: 2.71; CI 95%: 1.19-6.16; P=0.017) were predictors of restenosis after stent placement. Lipoprotein(a) and apolipoprotein(a) polymorphism did not enter the model as predictive variables.


CONCLUSIONS
Our study confirms that multiple stenting, diabetes and multivessel disease are powerful predictors of restenosis after intracoronary stent implantation. On the contrary, lipoprotein(a) and apolipoprotein(a) polymorphism do not appear to be reliable markers of restenosis in patients with stent implantation.
Gazzaruso
Carmine
C
Internal Medicine Unit, IRCCS Maugeri Foundation Hospital, Department of Internal Medicine and Medical Therapeutics, University of Pavia, Via Ferrata 8, 27100 Pavia, Italy. cgazzaruso@fsm.it
Garzaniti
Adriana
A
Falcone
Colomba
C
Geroldi
Diego
D
Turpini
Chiara
C
Fratino
Pietro
P
D000704:Analysis of Variance; D001054:Apolipoproteins A / Q000097:blood* / Q000235:genetics*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood* / Q000235:genetics* / Q000628:therapy; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood; D016015:Logistic Models; D010641:Phenotype; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015607:Stents
D001054:Apolipoproteins A; D017270:Lipoprotein(a)