title: Lipoprotein (a) is related to coronary atherosclerotic burden and a vulnerable plaque phenotype in angiographically obstructive coronary artery disease.
abstract: BACKGROUND
  Lipoprotein Lp(a) has been shown to be an independent risk factor for coronary artery disease (CAD). However, its association with CAD burden in patients with ACS is largely unknown, as well as the association of Lp(a) with lipid rich plaques prone to rupture.
  
  
  OBJECTIVE
  We aim at assessing CAD burden by coronary angiography and plaque features including thin cap fibroatheroma (TCFA) by optical coherence tomography (OCT) in consecutive patients presenting with acute coronary syndrome (ACS) and obstructive CAD along with serum Lp(a) levels.
  
  
  METHODS
  This study comprises an angiographic and an OCT cohort. A total of 500 ACS patients (370 men, average age 66 ± 11) were enrolled for the angiographic cohort and 51 ACS patients (29 males, average age 65 ± 11) were enrolled for the OCT cohort. Angiographic CAD severity was assessed by Sullivan score and by Bogaty score including stenosis score and extent index. OCT plaque features were evaluated at the site of the minimal lumen area and along the culprit segment.
  
  
  RESULTS
  In the angiographic cohort, at multivariate analysis, Lp(a) was a weak independent predictor of Sullivan score (p < 0.0001), stenosis score (p < 0.0001) and extent index (p < 0.0001). In the OCT cohort, patients with higher Lp(a) levels (≥ 30 md/dl) compared to patients with lower Lp(a) levels (<30 md/dl) exhibited a higher prevalence of lipidic plaque at the site of the culprit stenosis (67% vs. 27%; P = 0.02), a wider lipid arc (135 ± 114 vs 59 ± 111; P = 0.03) and a higher prevalence of TCFA (38% vs. 10%; P = 0.04).
  
  
  CONCLUSIONS
  Among patients with ACS, raised Lp(a) levels are associated with an increased atherosclerotic burden and it identifies a subset of patients with features of high risk coronary atherosclerosis.
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gniccoli73@hotmail.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Cin
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy; Thorax Institute, Hospital Clinic, University of Barcelona, Spain.
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Panebianco
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Sofia
authors.initials: S
authors.lastname: Abbolito
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Jacoangeli
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy; Cardiology Department, Zagazig University, Zagazig, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Refaat
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Gallo
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Salerno
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.affiliation: Cardiology Department, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: Cardiology Department, Department of Clinical and Molecular Medicine, 2nd School of Medicine, University of Rome "Sapienza", S.Andrea Hospital, Rome, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: De Biase
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016014:Linear Models; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010641:Phenotype; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D017270:Lipoprotein(a)
keywords: Coronary artery disease; Lipoprotein(a); Optical coherence tomography; plaque morphology