To evaluate whether specific lipoprotein(a) apheresis on the top of optimal medical therapy could affect atherosclerotic disease burden in coronary and carotid arteries of coronary heart disease patients with elevated Lp(a) levels.
Following the hypothesis that if Lp(a) excess has a pathogenic role in atherogenesis, then specific elimination of circulating Lp(a) should affect plaque growth and stability, we evaluated the efficacy of Lp(a) apheresis on changes in coronary plaque volume and composition and carotid intima-media thickness in patients with CHD on the background of optimal medical treatment.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
32
Specific Lp(a) apheresis procedures were carried out weekly with "Lp(a) Lipopak" columns (POCARD Ltd., Moscow, Russia) according to the standard protocol
Russian Cardiology Research and Production Center
Moscow, Russia
Change in Percent Diameter Stenosis
The absolute change from baseline to 18 months in mean percent diameter stenosis, determined by quantitative coronary angiography (QCA) as the narrowest lesion in each segment and calculated as: ((reference diameter-minimal lumen diameter (MLD))/reference diameter)x100.
Time frame: From Baseline to End of Study (Week 72)
Change in mean carotid intima-media thickness (IMT)
Change from baseline in mean carotid IMT, as measured by duplex ultrasonography of common carotid arteries after 9 and 18 months.
Time frame: From Baseline to Week 36 (9 months) and to Week 72 (18 months)
Numbers of Coronary segments Showing Regression
Clinically relevant regression or progression was defined as a change from baseline to follow up of ≥10% for percent diameter stenosis
Time frame: From baseline to End of study (Week 72)
Number of Carotid Segments showing Regression
Carotid IMT progression criterion for the 18 months of treatment was considered as growth rate of 0.02 mm (0.015 mm/yr). No changes or reduction in carotid IMT ≥ 0,02 mm served as criterion of stabilization and regression of carotid atherosclerosis, respectively.
Time frame: From Baseline to End of study (Week 72)
Change in total atheroma volume (TAV) from baseline to 18 months post-therapy
TAV at baseline - TAV at Week 72 assessed by intravascular ultrasound (IVUS) imaging of a targeted coronary artery
Time frame: From Baseline to Week 72
Change in absolute volumes of plaque components
Mean change in absolute volumes of plaque components: fibrotic, fibrofatty, necrotic core or dense calcium, assessed by radiofrequency intravascular ultrasonographic (IVUS) imaging at baseline and 18 months post-therapy
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Time frame: From Baseline to Week 72
Change in relative amount of plaque components
Mean change in relative amounts of plaque components: fibrotic, fibrofatty, necrotic core or dense calcium, assessed by radiofrequency intravascular ultrasonographic (IVUS) imaging at baseline and 18 months post-therapy
Time frame: From baseline to Week 72
Numbers of Coronary Plaques Showing Regression
Regression was defined as decrease in TAV for all anatomically comparable cross sectional areas of targeted coronary artery from baseline of ≥ 0,1 mm cubed
Time frame: From baseline to End of study (Week 72)
Acute change in Lp(a) level
Difference in Lp(a) concentration before and after specific Lp(a) apheresis procedure calculated as the mean of all measurements
Time frame: Once a week over 72 week period of active treatment
Change in quality of life (QOL)
To evaluate the impact of the specific Lp(a) removal therapy on the quality of life using Seattle Angina Questionnaire (SAQ) and Exercise stress test as compared with standard guideline-driven medical therapy of CHD patients
Time frame: from baseline to week 72