Lipoprotein(a)-to-HDL-C ratio and risk of repeat revascularization and in-stent restenosis after PCI in patients with chronic coronary syndrome undergoing follow-up coronary imaging.

BACKGROUND: We proposed a novel lipoprotein(a)-to-HDL-C ratio (LHR) and examined its association with repeat revascularization and in-stent restenosis (ISR) in patients with chronic coronary syndrome (CCS) after percutaneous coronary intervention (PCI). METHODS: A total of 2,238 patients with CCS undergoing DES-PCI who had available follow-up coronary imaging were included and categorized into tertiles according to lnLHR values. The primary outcome was a composite of repeat revascularization and ISR. Kaplan-Meier analysis, multivariable Cox regression, restricted cubic spline analysis, and prediction model evaluation were performed. RESULTS: During a median follow-up of 60 months, 1,031 patients (46.07%) experienced the primary endpoint. Higher lnLHR tertiles were associated with lower event-free survival (p = 0.002). After multivariable adjustment, lnLHR remained independently associated with the primary endpoint (HR, 1.08; 95% CI, 1.02-1.14; p = 0.009), and patients in the highest tertile had a higher risk than those in the lowest tertile (HR, 1.19; 95% CI, 1.02-1.39; p = 0.026). RCS analysis demonstrated a linear association between lnLHR and outcomes. The LHR-based model showed modest discrimination, with AUCs of 0.629 at 3 years and 0.648 at 5 years. CONCLUSIONS: An elevated LHR was independently associated with an increased risk of repeat revascularization and ISR after PCI in CCS patients. These findings suggest that LHR may serve as a complementary lipid-related marker for long-term risk stratification in this population.