Abstract 4360462: Impact of lipoprotein(a) levels on subsequent cardiovascular events after endovascular therapy for femoropopliteal lesion

Background: Patients with peripheral arterial disease (PAD) have a poor prognosis due to the presence of multiple comorbidities. PAD is associated with a greater systemic atherosclerotic burden and serves as a marker of a malignant vascular phenotype, particularly in cases of polyvascular disease. Previous studies have shown that PAD is linked to an increased risk of cardiovascular events. Although lipoprotein(a) [Lp(a)] has been identified as a useful prognostic marker in patients with coronary artery disease, its relationship with subsequent cardiovascular events in PAD patients remains unclear. Hypothesis: We investigated whether elevated Lp(a) levels are associated with an increased risk of subsequent cardiovascular events in patients undergoing endovascular therapy (EVT) for PAD. Methods: We conducted a retrospective analysis using a single-centre database. A total of 138 patients who underwent EVT for de novo femoropopliteal lesions between June 2016 and December 2022 were included. Lp(a) levels were measured in all patients prior to EVT. Based on previous literature, a cut-off value of 30 mg/dL was used to classify patients into two groups: low Lp(a) (<30 mg/dL) and high Lp(a) (≥30 mg/dL). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of acute coronary syndrome (ACS), heart failure, stroke, and cardiovascular death. Results: Of the 138 patients, 45 (32.6%) were classified into the high Lp(a) group and 93 (67.4%) into the low Lp(a) group. Lp(a) levels were not normally distributed. Kaplan–Meier analysis revealed that the incidence of MACE was significantly higher in the high Lp(a) group than in the low Lp(a) group (Figure 1). Although the incidences of ACS, stroke, and cardiovascular death were not significantly different between the groups, the incidence of heart failure was significantly higher in the high Lp(a) group (Figure 2). Conclusion: Elevated Lp(a) levels were associated with an increased risk of MACE, particularly heart failure, in patients with PAD undergoing EVT.