Lipoprotein(a) as a predictor of poor collateral circulation in patients with chronic stable coronary heart disease

As a mechanism compensating for obstructive coronary artery disease, coronary collateral circulation (CCC) has attracted cardiologists for a long time to explore its potential impact. In the present study, Chinese patients suffering from ≥95% coronary stenosis, as diagnosed by angiography, have been investigated for the correlation between CCC and lipoprotein(a) [Lp(a)] levels. A cohort of 654 patients was divided into four categories according to Rentrop grades 0, 1, 2, and 3. Lp(a) levels were divided into model 1, discretized with critical values of 33 and 66%, and model 2, discretized with a cutoff value of 30.0 mg/dL. Furthermore, we evaluated the correlation between CCC and serum Lp(a) levels. The four groups had significantly different Lp(a) levels (25.80±24.72, 18.99±17.83, 15.39±15.80, and 8.40±7.75 mg/dL; P<0.001). In model 1, concerning R0, the risk in the third Lp (a) tertile (OR=3.34, 95%CI=2.32-4.83) was greater than that in the first tertile. In model 2, concerning R0, the risk in Lp(a) >30.0 group (OR=6.77, 95%CI=4.44-10.4) was greater than that of Lp(a) <30.0 mg/dL. The worst condition of CCC can be predicted independently by Lp(a) levels. In addition to clinical usage, Lp(a) levels can also be utilized as biological markers.

作为一种代偿阻塞性冠状动脉疾病的机制，冠状动脉侧支循环（coronary collateral circulation, CCC）长期以来一直受到心脏病学家的关注，以探索其潜在影响。本研究针对经血管造影确诊为冠状动脉狭窄≥95%的中国患者，探讨了CCC与脂蛋白(a)[lipoprotein(a), Lp(a)]水平之间的相关性。研究纳入654例患者队列，根据Rentrop分级分为0、1、2、3级共4个类别。Lp(a)水平采用两种离散化方案分组：模型1以33%和66%作为临界值进行离散化，模型2以30.0 mg/dL作为截断值进行分组。此外，本研究评估了CCC与血清Lp(a)水平的相关性。结果显示，4组患者的Lp(a)水平存在显著差异（25.80±24.72、18.99±17.83、15.39±15.80、8.40±7.75 mg/dL；P<0.001）。在模型1中，以R0组为参照，Lp(a)三分位组中的第三组（OR=3.34，95%CI=2.32-4.83）的发病风险高于第一三分位组。在模型2中，以R0组为参照，Lp(a)>30.0 mg/dL组（OR=6.77，95%CI=4.44-10.4）的发病风险高于Lp(a)<30.0 mg/dL组。Lp(a)水平可独立预测CCC的严重程度。除临床应用外，Lp(a)水平还可作为生物标志物加以利用。