{"id":"5e43a2fb5ceb","type":"article","url":"https://hartvaat.nl/2026/05/21/bij-coronaire-vasospasmen-zonder-significante-stenose-voorspelt-verhoogd-lp-a-ge/","title":"Bij coronaire vasospasmen zonder significante stenose voorspelt verhoogd Lp(a) geen MACE","title_en":"","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","biomarkers-cardiovasculair","ezetimibe","fractional-flow-reserve","obesitas","ouderen","perifeer-vaatlijden","roken","stabiel-coronairlijden"],"journal":"Heart and vessels","doi":"10.1007/s00380-026-02669-0","source_url":"https://doi.org/10.1007/s00380-026-02669-0","authors":["Woo Jin Ahn","Seung-Woon Rha","Byoung Geol Choi","Se Yeon Choi","Jae Kyeong Byun","Youjin Lee","Manda Satria Chesario","Melly Susanti","Wonsang Chu","Jieun Lee","Soohyung Park","Eun Jin Park","Dong Oh Kang","Cheol Ung Choi","Chang Gyu Park","Dong Joo Oh"],"significance":5,"published":"2026-06-08","source_date":"2026-05-21","image":"https://hartvaat.nl/global/img/6e8531206aa4.webp","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"Observational study in 1,373 patients with positive intracoronary acetylcholine provocation and non-significant coronary stenosis, stratified into high Lp(a) (≥50 mg/dL) versus low Lp(a) (<50 mg/dL). 10-year MACE, MACCE and MACCE with recurrent angina were compared using inverse probability of treatment weighting and Cox regression. No significant differences emerged in MACE, MACCE or MACCE with angina between Lp(a) strata. A small increase in revascularisations with high Lp(a) (3.3% vs 0.9%) disappeared after adjustment. While Lp(a) remains an established overall cardiovascular risk factor, it adds little prognostic value in vasospastic angina without obstructive coronary disease.","created":"2026-07-03T10:33:00Z","updated":"2026-07-03T13:31:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Observationele studie bij 1.373 patiënten met positieve acetylcholine-provocatietest (intracoronair) en niet-significante coronaire stenose, opgesplitst in hoog Lp(a) (≥50 mg/dL) versus laag Lp(a) (<50 mg/dL). 10-jaars MACE, MACCE en MACCE met recidiverende angina werden vergeleken via inverse probability of treatment weighting en Cox-regressie. Er was geen significant verschil in MACE, MACCE of MACCE met angina tussen beide Lp(a)-groepen. Een kleine toename in revascularisaties bij hoog Lp(a) (3,3% vs 0,9%) verdween na correctie. Hoewel Lp(a) een vastgestelde algemene cardiovasculaire risicofactor blijft, voegt het bij vasospastische angina zonder obstructief coronairlijden weinig prognostische waarde toe.","abstract_original":"Lipoprotein(a) [Lp(a)] has recently regained attention in prognostic research. However, data remain limited for patients without significant coronary artery stenosis confirmed angiographically and those who do not undergo percutaneous coronary intervention (PCI), and studies focusing specifically on patients with coronary artery spasm (CAS) are even more scarce. In this study, a total of 1,373 patients with positive intracoronary provocation testing with acetylcholine (ACH) and insignificant coronary artery stenosis were divided into two groups based on Lp(a) levels: the high Lp(a) group (≥50 mg/dL) and the low Lp(a) group (< 50 mg/dL). The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE1) and MACCE1 with recurrent angina (MACCE2). Multiple imputation was followed by inverse probability of treatment weighting (IPTW), and Cox regression analysis was used to analyze 10-year clinical outcomes. There was no significant difference in MACE, MACCE1, or MACCE2 between the two groups. Before IPTW adjustment, the high Lp(a) group had a higher incidence of revascularization (0.9% vs. 3.3%; p = 0.033), but this difference was not significant after IPTW adjustment (p = 0.118). Although there was no significant group difference, a notable proportion of patients experienced recurrent angina requiring angiography (25.3% vs. 30.8%; p = 0.615). In conclusion, although Lp(a) is an established independent risk factor, it did not show prognostic significance in CAS patients in the absence of significant coronary artery stenosis and PCI."}