Lipoprotein(a) and Triglycerides as Independent Predictors of Long-Term Aortoiliac Stent Failure After Endovascular Revascularisation

Background: Restenosis and occlusion remain important after aortoiliac stenting, and device choice does not fully explain late patency loss. Lipoprotein(a) [Lp(a)] is implicated in atherosclerotic progression and residual vascular risk. Objective: To determine whether baseline Lp(a) is associated with long-term restenosis or occlusion after aortoiliac stenting. Methods: This post hoc biomarker analysis of COBEST included 125 patients and 168 treated iliac arteries randomised to the Advanta V12 covered stent (Atrium Medical Corporation, Hudson, NH, USA) or bare-metal stents for symptomatic aortoiliac occlusive disease. The primary outcome was loss of primary patency, defined as restenosis or occlusion during 5-year follow-up. Cox proportional hazards modelling and cumulative failure curves were the main analyses. Results: In the Lp(a)-adjusted Cox model, covered stent use was associated with a lower hazard of restenosis or occlusion (HR, 0.55; 95% CI, 0.31–0.97; p = 0.039), whereas each 1 mg/dL higher Lp(a) concentration was associated with a higher hazard (HR, 1.08; 95% CI, 1.06–1.10; p < 0.001; equivalent to HR, 2.16; 95% CI, 1.79–2.59 per 10 mg/dL increase). In the biomarker-adjusted model, each 1 mg/dL higher Lp(a) concentration (HR, 1.05; 95% CI, 1.02–1.08; p < 0.001; HR, 1.63; 95% CI, 1.22–2.16 per 10 mg/dL increase) and each 1 mmol/L higher triglyceride concentration (HR, 1.89; 95% CI, 1.34–2.68; p < 0.001) remained associated with restenosis or occlusion. Conclusions: Elevated Lp(a) and, to a lesser extent, triglycerides were independently associated with long-term aortoiliac stent failure after adjustment for stent type.