TY - JOUR
T1 - Impact of serum lipoprotein(a) on endothelium-dependent coronary vasomotor response assessed by intracoronary acetylcholine provocation
AU - Mashaly, Ahmed
AU - Rha, Seung-Woon
AU - Choi, Byoung Geol
AU - Baek, Man Jong
AU - Ryu, Yang Gi
AU - Choi, Se Yeon
AU - Byun, Jae Kyeong
AU - Abdelshafi, Kareem
AU - Park, Yoonjee
AU - Jang, Won Young
AU - Woohyeun, Kim
AU - Park, Eun Jin
AU - Choi, Jah Yeon
AU - Na, Jin Oh
AU - Choi, Cheol Ung
AU - Lim, Hong Euy
AU - Kim, Eung Ju
AU - Park, Chang Gyu
AU - Seo, Hong Seog
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic vascular disease. However, there are limited data regarding the impact of Lp(a) levels on the incidence and severity of endothelium-dependent coronary vasomotor response. Patients and methods A total of 2416 patients without significant coronary artery lesion (<50% stenosis) by coronary angiography and underwent acetylcholine (ACh) provocation test were enrolled and categorized according to their serum Lp(a) level into four quartile groups: less than 6.70, 6.70-13.30, 13.30-26.27, and more than 26.27 mg/dl. The aim of this study is to estimate the incidence and severity of endothelium-dependent positive ACh provocation test in each group; moreover, to access the incidence of major adverse cardiovascular events, the composite of total death, myocardial infarction, and de novo percutaneous coronary intervention were compared between the four groups up to 5 years. Results The group with higher Lp(a) had a higher incidence of coronary heart disease, myocardial infarction, and peripheral arterial disease history. However, there was no difference among the four groups as regards the incidence of positive ACh provocation test, spasm severity, spasm extent, and location. However, at up to 5 years of clinical follow-up, the higher-Lp(a) group showed higher total death, de novo percutaneous coronary intervention, recurrent angina, and total major adverse cardiovascular events compared with the lower-Lp(a) groups. Conclusion In our study, there was no relationship between the elevated Lp(a) level and the vasospastic response to the intracoronary ACh provocation test; however, higher Lp(a) levels were associated with poor clinical outcomes up to 5 years.
AB - Background Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic vascular disease. However, there are limited data regarding the impact of Lp(a) levels on the incidence and severity of endothelium-dependent coronary vasomotor response. Patients and methods A total of 2416 patients without significant coronary artery lesion (<50% stenosis) by coronary angiography and underwent acetylcholine (ACh) provocation test were enrolled and categorized according to their serum Lp(a) level into four quartile groups: less than 6.70, 6.70-13.30, 13.30-26.27, and more than 26.27 mg/dl. The aim of this study is to estimate the incidence and severity of endothelium-dependent positive ACh provocation test in each group; moreover, to access the incidence of major adverse cardiovascular events, the composite of total death, myocardial infarction, and de novo percutaneous coronary intervention were compared between the four groups up to 5 years. Results The group with higher Lp(a) had a higher incidence of coronary heart disease, myocardial infarction, and peripheral arterial disease history. However, there was no difference among the four groups as regards the incidence of positive ACh provocation test, spasm severity, spasm extent, and location. However, at up to 5 years of clinical follow-up, the higher-Lp(a) group showed higher total death, de novo percutaneous coronary intervention, recurrent angina, and total major adverse cardiovascular events compared with the lower-Lp(a) groups. Conclusion In our study, there was no relationship between the elevated Lp(a) level and the vasospastic response to the intracoronary ACh provocation test; however, higher Lp(a) levels were associated with poor clinical outcomes up to 5 years.
KW - coronary artery spasm
KW - endothelial dysfunction
KW - intracoronary acetylcholine provocation test
KW - lipoprotein(a)
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U2 - 10.1097/MCA.0000000000000642
DO - 10.1097/MCA.0000000000000642
M3 - Article
C2 - 29912783
AN - SCOPUS:85051271702
VL - 29
SP - 516
EP - 525
JO - Coronary Artery Disease
JF - Coronary Artery Disease
SN - 0954-6928
IS - 6
ER -