Impact of serum lipoprotein(a) on endothelium-dependent coronary vasomotor response assessed by intracoronary acetylcholine provocation

Ahmed Mashaly, Seung Woon Rha, Byoung Geol Choi, Man Jong Baek, Yang Gi Ryu, Se Yeon Choi, Jae Kyeong Byun, Kareem Abdelshafi, Yoonjee Park, Won Young Jang, Kim Woohyeun, Eun Jin Park, Jah Yeon Choi, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo

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5 Citations (Scopus)


Background Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic vascular disease. However, there are limited data regarding the impact of Lp(a) levels on the incidence and severity of endothelium-dependent coronary vasomotor response. Patients and methods A total of 2416 patients without significant coronary artery lesion (<50% stenosis) by coronary angiography and underwent acetylcholine (ACh) provocation test were enrolled and categorized according to their serum Lp(a) level into four quartile groups: less than 6.70, 6.70-13.30, 13.30-26.27, and more than 26.27 mg/dl. The aim of this study is to estimate the incidence and severity of endothelium-dependent positive ACh provocation test in each group; moreover, to access the incidence of major adverse cardiovascular events, the composite of total death, myocardial infarction, and de novo percutaneous coronary intervention were compared between the four groups up to 5 years. Results The group with higher Lp(a) had a higher incidence of coronary heart disease, myocardial infarction, and peripheral arterial disease history. However, there was no difference among the four groups as regards the incidence of positive ACh provocation test, spasm severity, spasm extent, and location. However, at up to 5 years of clinical follow-up, the higher-Lp(a) group showed higher total death, de novo percutaneous coronary intervention, recurrent angina, and total major adverse cardiovascular events compared with the lower-Lp(a) groups. Conclusion In our study, there was no relationship between the elevated Lp(a) level and the vasospastic response to the intracoronary ACh provocation test; however, higher Lp(a) levels were associated with poor clinical outcomes up to 5 years.

Original languageEnglish
Pages (from-to)516-525
Number of pages10
JournalCoronary artery disease
Issue number6
Publication statusPublished - 2018 Sept 1

Bibliographical note

Publisher Copyright:
© Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.


  • coronary artery spasm
  • endothelial dysfunction
  • intracoronary acetylcholine provocation test
  • lipoprotein(a)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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