Predictive value of lipoprotein(a) in patients undergoing percutaneous coronary intervention with drug-eluting stent: A meta-analysis

Abstract

BACKGROUND Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis. Drug-eluting stents (DES) were developed to delay the progression of atherosclerosis. However, the diagnostic and prognostic value of Lp(a) in patients undergoing percutaneous coronary intervention (PCI) with DES remains unknown. OBJECTIVE We aim to evaluate the prognostic impact of serum Lp(a) level on cardiovascular outcomes and predictive value on repeat revascularization in patients undergoing PCI with DES. METHODS We conducted a literature search from the inception of PubMed to May 2025. Eligible studies include adult patients, with the majority ('90%) undergoing PCI with DES. Primary outcomes were the prognostic value of Lp(a) in predicting major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular (CV) mortality, and all-cause mortality. Secondary outcomes were the diagnostic value of Lp(a) for repeat revascularization, target vessel revascularization (TVR), and target lesion revascularization (TLR) evaluated in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). RESULTS Eleven cohorts were included, comprising a total of 27,618 patients (mean age 61 ± 10.2 years, mean follow-up 4.5 ± 1.98 years). For primary outcomes, high Lp(a) level was associated with increased risks of MACE (odds ratio [OR] 1.25, 95% CI 1.09-1.42), MI (OR 1.75, 95% CI 1.08-2.83), stroke (OR 1.28, 95% CI 1.04-1.59), CV mortality (OR 1.37, 95% CI 1.02-1.83), and all-cause mortality (OR 1.29, 95% CI 1.04-1.59). For secondary outcomes, high Lp(a) level showed sensitivity of 46%, 35%, and 39% and specificity of 64%, 74%, and 79% in predicting repeat revascularization, TLR, and TVR, respectively. The AUROC for repeat revascularization, TLR, and TVR were 0.527, 0.536, and 0.537, respectively. CONCLUSION High Lp(a) level in patients who underwent PCI with DES was associated with poor prognosis; however, the predictive value of Lp(a) in this population remains inconclusive.