Abstract
Background: Elevated lipoprotein(a) (Lp[a]) levels are implicated in the development of peripheral artery disease (PAD) and in major adverse limb events (MALE) across a range of PAD severity. The association between Lp(a) level and adverse events in patients with chronic limb threatening ischemia (CLTI) remains uncertain. Research Questions: Does Lp(a) level associate with MALE and death in patients with CLTI undergoing revascularization? Goals/Aims: To assess the association of Lp(a) level with MALE and death in patients with CLTI undergoing revascularization. Methods: The BEST-CLI trial was a randomized trial assessing the optimal revascularization strategy in patients with CLTI. A subgroup of patients underwent lipid and Lp(a) assessment during the study period and were included. The primary outcome was the first death or MALE event (above-ankle amputation or major reintervention). Hazard ratios were calculated using Cox proportional hazards models, adjusting for age, sex, statin use, and glomerular filtration rate. Results: A total of 192 patients (median [IQR] age, 67.5 [62.1, 74.2] years; 139 men [72.4%]) were included in the cohort. Median Lp(a) level was 26.8 [10.8, 65.1] with normal Lp(a) levels (<30 mg/dL) observed in 104 patients, high levels (30-111 [the 90 th percentile] mg/dL) in 68 patients, and very high levels (>111 mg/dL) in 20 patients. The primary outcome occurred in 75 (39.1%) patients, including 42 (40.4%), 25 (36.8%), and 8 (40.0%) patients with normal, high, and very high Lp(a) levels. There was no association between Lp(a) and the primary outcome (HR 1.00, 95% CI 0.99-1.02, Figure 1). A significant association between Lp(a) and death (HR 1.03, 95% CI 1.01-1.05) was noted. Results did not vary by randomized revascularization procedure. Conclusion: In this cohort, Lp(a) predicts death but not limb events in patients with CLTI. Larger studies are needed to understand the role of Lp(a) in patients with CLTI undergoing revascularization.
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