As an addition to the extensive review of coronary in-stent restenosis (1) by Hellen Ullrich and co-authors, I would like to point out that lipid metabolism disorders should also be regarded as patient-dependent risk factors. Thus, patients with elevated lipoprotein (a) levels have an increased risk of in-stent restenosis.
Zairis et al. identified lipoprotein (a) as an independent risk parameter for restenosis in a study of 483 patients with coronary stenting (2). Other studies came to similar conclusions (3).
In our center, of the ten patients who are currently undergoing lipid apheresis for lipoprotein (a) metabolic disorders, three have a history with a total of five events of in-stent coronary restenosis.
The occurrence of in-stent restenosis, especially when other risk factors have already been optimized, should prompt an assessment of the lipoprotein (a) metabolism. As in-stent restenosis ultimately corresponds to progression of the cardiovascular disease, lipid apheresis can often be used as a therapy option for these patients.
References
- 1.Ullrich H, Olschewski M, Münzel T, Gori T. Coronary in-stent restenosis—predictors and treatment. Dtsch Arztebl Int. 2021;118:637–644. doi: 10.3238/arztebl.m2021.0254. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Zairis MN, Ambrose JA, Manousakis SJ, et al. The impact of plasma levels of C-reactive protein, lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting: the global evaluation of new events and restenosis after stent implantation study. J Am Coll Cardio. 2002;40:1375–1382. doi: 10.1016/s0735-1097(02)02267-2. [DOI] [PubMed] [Google Scholar]
- 3.Qin S, Liu J, Jiang H, Hu B, Zhou Y, Olkkonen VM. Association between baseline lipoprotein (a) levels and restenosis after coronary stenting: meta-analysis of 9 cohort studies. Atherosclerosis. 2013;227:360–366. doi: 10.1016/j.atherosclerosis.2013.01.014. [DOI] [PubMed] [Google Scholar]