{
  "abstract": "Background: Long-term outcomes differ substantially among patients with chronic total occlusion (CTO), and risk assessment remains challenging. Lipoprotein(a) [Lp(a)] and hyperuricemia are both associated with cardiovascular risk, but the prognostic significance of their coexistence in this population is uncertain.\n\nMethods: We retrospectively studied 391 patients with angiographically confirmed CTO. Patients were classified into four groups according to baseline Lp(a) and uric acid (UA) levels: neither elevated, elevated lipoprotein(a) only, hyperuricemia only, and both elevated. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as the first occurrence of all-cause death, non-fatal myocardial infarction, target vessel revascularization, or stroke. Cox regression was used to assess long-term associations, while additive and multiplicative interactions were examined. Incremental prognostic value was evaluated using model discrimination, reclassification, calibration, and bootstrap internal validation.\n\nResults: During a median follow-up of 73 months, event rates were 12.21%, 29.89%, 28.57%, and 66.27% across the four groups, respectively (P<0.001). Patients with both elevated lipoprotein(a) and hyperuricemia had the highest event risk compared with those with neither factor elevated (adjusted hazard ratio [aHR] 11.46, 95% confidence interval [CI] 6.44–20.41; P<0.001). In a sensitivity analysis restricted to all-cause death, non-fatal myocardial infarction, or stroke, the association remained significant (aHR 4.23, 95% CI 2.13–8.39; P<0.001). A positive additive interaction was observed, whereas the multiplicative interaction was not significant. The apparent C-indices were 0.691 and 0.828 for the Base and Expanded models, respectively; after bootstrap optimism correction, the corresponding C-indices were 0.634 and 0.791.\n\nConclusions: Concurrent elevation of Lp(a) and UA was associated with higher long-term cardiovascular risk in patients with CTO and may provide prognostic information beyond either marker considered alone. These findings require external validation before the proposed dual-biomarker classification can be applied clinically.",
  "abstract_shown": true,
  "affiliations": [
    "Cardiology Department, The First Affiliated Hospital of Anhui Medical University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jian Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "BingBing Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jun Xie"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9mxp2hmd901f2.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1980408",
  "fulltext_url": null,
  "id": "9mxp2hmd901f2",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1980408/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/9mxp2hmd901f2.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:21:23Z",
      "native_id": "10.3389/fendo.2026.1980408",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1980408/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2392",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Joint association and interaction of lipoprotein(a) and hyperuricemia with long-term outcomes in chronic total occlusion",
  "title_text": "Joint association and interaction of lipoprotein(a) and hyperuricemia with long-term outcomes in chronic total occlusion",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T00:23:07Z",
  "url": "https://research.draconitic.com/paper/9mxp2hmd901f2",
  "venue": "Frontiers in Endocrinology",
  "versions": []
}