Impact of elevated lipoprotein(a) on epicardial coronary flow conductance and endoluminal atherosclerotic disease distribution

Renkens, Mick P. L., Tsai, Tsung-Ying, Revaiah, Pruthvi C., Kageyama, Shigetaka, Reiber, Johan H. C., de Winter, Robbert J., Grundeken, Maik, Nurmohamed, Nick S., Stroes, Erik, Garg, Scot, von Birgelen, Clemens, Hofma, Sjoerd, Alkhalil, Mohammad, Rosseel, Liesbeth, Sharif, Faisal, Smits, Pieter C., Baumbach, Andreas, Onuma, Yoshinobu, Wykrzykowska, Joanna J., Serruys, Patrick W. (2025). Impact of elevated lipoprotein(a) on epicardial coronary flow conductance and endoluminal atherosclerotic disease distribution. Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2025.07.003

Abstract

In this PIONEER IV sub-study (NCT04923191), we investigated the effect of elevated lipoprotein(a) [Lp(a)] on epicardial coronary flow and endoluminal disease distribution. We analyzed 392 vessels from 75 propensity-matched pairs using Quantitative Flow Ratio (QFR) to assess flow limitation and the virtual QFR-Pressure Pullback Gradient Index (QFR-PPGi) to characterize disease distribution patterns (focal versus diffuse). Vessels exposed to elevated Lp(a) exhibited significantly higher rates of epicardial flow limitation (QFR ≤ 0.80) than controls (31 % vs. 19 %, absolute risk difference 12 %; 95 % CI: 2.7 %–21 %, p = 0.011). The median difference in baseline QFR between matched vessels was −0.045 (p = 0.005), while the mean difference in QFR-PPGi was −0.028 (p = 0.013). These findings demonstrate that elevated Lp(a) levels are associated with both greater epicardial flow limitation and a more diffuse pattern of coronary artery disease.

Funder

SINOMED (Tianjin, China)

Publisher

Elsevier

Rights

CC BY

cb

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Medicine (Scholarly Articles)