SAT-277 Efficacy And Safety Of Lipoprotein Apheresis In ASCVD Patients With Elevated Lipoprotein(a): A Multicenter Retrospective Study

Abstract Disclosure: T. McGinnis: None. P.M. Moriarty: None. A.B. Fernandez: None. S.J. Saucier: None. S.P. Babirak: None. A. Bajaj: None. D. Saxon: None. Background: Lipoprotein(a) [Lp(a)] is a genetically determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD). While elevated Lp(a) confers increased cardiovascular risk, therapeutic options to lower it remain limited. Lipoprotein apheresis (LA) is the only FDA-approved therapy for reducing Lp(a), but real-world data on its long-term use are lacking. Objective: To evaluate the long-term efficacy and safety of LA in patients with ASCVD and Lp(a) >60 mg/dL. Methods: We conducted a multi-center, retrospective chart review of 60 patients with ASCVD and Lp(a) >60 mg/dL who underwent LA with the LA-15 system between 2012 and 2025 across five U.S. centers. Patients were followed for 1-5 years. Outcomes included changes in lipid levels, incidence of major adverse cardiac events (MACE: cardiovascular death, MI, PCI, CABG), major adverse non-cardiac events (MANCE: stroke, peripheral vascular events, VTE), and safety events. Results: Mean baseline Lp(a) was 144.2±84.7 mg/dL and LDL-C was 108.1±69.5 mg/dL. LA acutely reduced Lp(a) and LDL-C by approximately 70%, with sustained reductions over five years. MACE incidence declined by 75.4% in the first year (from 4.03 to 0.99 events per 100 patient-months, p<0.001), and remained low through year 5 (range: 0.51-1.73). MANCE incidence decreased by 94.5% during the first two years post-treatment compared to the two years prior (from 0.83-2.22 to 0.00-0.17 events per 100 patient-months, p=0.003), and remained low in subsequent years (range: 0.00-0.52). Cardiovascular event reductions were observed regardless of baseline LDL-C, including among patients with LDL-C <100 mg/dL. No treatment-related deaths occurred. Adverse events were generally mild, most commonly nausea/vomiting (44%) and chest pain (34%). One patient required hospitalization due to an adverse event. Conclusion: In patients with ASCVD and elevated Lp(a), LA significantly reduced Lp(a), LDL-C, and cardiovascular event rates, with durable benefits and a favorable safety profile over five years. These findings support broader consideration of LA in this high-risk population, independent of baseline LDL-C levels. Presentation: Saturday, July 12, 2025