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Publications

Journal Article Ahead of print

PubMed: 42859116 DOI: 10.1016/j.jacl.2026.08.021

"Lipoprotein(a) across coronary plaque phenotypes from high-risk to layered plaque: An OCT analysis from the RELACS registry".

J Clin Lipidol

Authors: Vincenzo Acerbo, Arturo Cesaro, Flavio Giuseppe Biccirè, Alexis F Guédon, Vincenzo De Sio, Antonio Capolongo, Matteo Conte, Silvio Coletta, Vincenzo Diana, Elisabetta Moscarella, Felice Gragnano, Italo Porto, Rocco Vergallo, Francesco Prati, Paolo Calabrò

Affiliations

  • Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (Acerbo, Cesaro, De Sio, Capolongo, Moscarella, Gragnano, and Calabrò); Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy (Acerbo, Cesaro, De Sio, Capolongo, Conte, Coletta, Diana, Moscarella, Gragnano, and Calabrò).
  • Cardiothoracic Department, San Giovanni-Addolorata Hospital, Rome, Italy (Biccirè and Prati); Department of General and Specialized Surgery 'Paride Stefanini', Sapienza University of Rome, Rome, Italy (Biccirè and Prati).
  • Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France (Guédon); Sorbonne Université, service de médecine interne, AP-HP, Hôpital Saint Antoine, Paris, France (Guédon).
  • Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy (Acerbo, Cesaro, De Sio, Capolongo, Conte, Coletta, Diana, Moscarella, Gragnano, and Calabrò).
  • IRCCS Ospedale Policlinico San Martino, Genoa, Italy (Porto and Vergallo); Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa 00186, Italy (Porto and Vergallo).
  • Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy (Acerbo, Cesaro, De Sio, Capolongo, Moscarella, Gragnano, and Calabrò); Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy (Acerbo, Cesaro, De Sio, Capolongo, Conte, Coletta, Diana, Moscarella, Gragnano, and Calabrò).

Abstract

BACKGROUND

Lipoprotein(a) [Lp(a)] is a causal risk factor for coronary artery disease, but its relationship with coronary plaque morphology assessed by optical coherence tomography (OCT) remains incompletely characterized.

OBJECTIVE

To investigate the association between circulating Lp(a) levels and OCT-defined coronary plaque phenotypes using a comprehensive segment-level approach.

METHODS

In this prospective single-center study (RELACS registry; NCT05496790), consecutive patients undergoing intracoronary OCT with available Lp(a) measurements were included. Coronary vessels were divided into 3 mm segments and analyzed for plaque characteristics. Lp(a) was primarily modeled as a continuous variable to assess its association with OCT-defined plaque phenotypes, including high-risk, layered, and fibrous plaques. High-risk plaque was defined as the presence of ≥2 criteria between lipid-rich plaque, thin-cap fibroatheroma (TCFA), and macrophages. Mixed-effects logistic regression models were used to account for within-patient clustering.

RESULTS

A total of 952 coronary segments from 50 patients were analyzed. Increasing Lp(a) levels were significantly associated with multiple features of plaque vulnerability, including TCFA, lipid-rich plaques, macrophages, and microchannels. In the multivariate mixed-effects analysis, higher Lp(a) levels were independently associated with a greater likelihood of high-risk plaque (odds ratios [OR] 1.31, 95% CI 1.16-1.48; P < .001) and layered plaques (OR 1.15, 95% CI 1.02-1.29; P = .024), whereas an inverse association was observed with fibrous plaques (OR 0.84, 95% CI 0.70-1.00; P = .047).

CONCLUSION

Increasing Lp(a) levels were associated with OCT-defined coronary plaque phenotypes related to vulnerability and instability, including high-risk and layered plaques. Given the limited patient-level sample size, these findings should be considered exploratory and hypothesis-generating.

MeSH

Registries, Macrophages, Lipoproteins, Phenotype, Tomography, Optical Coherence, Lipoprotein(A)