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Published on: October 12, 2017
Impact of Lipoprotein(a) concentrations on long-term cardiovascular outcomes in patients undergoing percutaneous
Kongyong Cui1, Dong Yin1, Chenggang Zhu1
1Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
Insights
Elevated lipoprotein(a) [Lp(a)] levels increase the risk of major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI). This risk is particularly pronounced in older patients and those with complex coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Clinical Cardiology
- Biomarkers
Background:
- The prognostic significance of lipoprotein(a) [Lp(a)] in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) is debated.
- Understanding Lp(a)'s role is crucial for risk stratification and treatment guidance in post-PCI patients.
Purpose of the Study:
- To investigate the association between Lp(a) levels and clinical outcomes in patients who have undergone PCI.
- To clarify the prognostic value of Lp(a) in this specific patient cohort.
Main Methods:
- Prospective enrollment of 10,059 CAD patients undergoing PCI.
- Categorization of patients based on Lp(a) levels (≤30 mg/dl vs. >30 mg/dl).
- Multivariate Cox regression and propensity-score matching analyses to assess major adverse cardiovascular and cerebrovascular events (MACCE).
Main Results:
- Elevated Lp(a) levels were associated with a significantly higher risk of MACCE (composite of death, myocardial infarction, stroke, or revascularization) at 2.4 years post-PCI.
- Propensity-score matching confirmed this association, with higher MACCE rates in the elevated Lp(a) group (HR 1.167, P=0.026).
- The predictive value of Lp(a) was more pronounced in patients >65 years and those with left main and/or three-vessel disease.
Conclusions:
- Elevated Lp(a) levels are a significant risk factor for adverse cardiovascular and cerebrovascular events in patients after PCI.
- The findings highlight the importance of Lp(a) as a prognostic marker, especially in elderly patients and those with extensive coronary artery disease.
Background And Aims:
Till now, the prognostic value of lipoprotein(a) [Lp(a)] in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) remains controversial. We therefore conducted this study to evaluate the effect of Lp(a) levels on clinical outcomes in this population.
Methods And Results:
A total of 10,059 CAD patients who underwent PCI were prospectively enrolled in this cohort study, of which 6564 patients had Lp(a) ≤30 mg/dl and 3495 patients had Lp(a) > 30 mg/dl. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, stroke or unplanned revascularization. Multivariate Cox regression analysis and propensity-score matching analysis were performed. After propensity-score matching, 3449 pairs of patients were identified, and post-matching absolute standardized differences were <10% for all the covariates. At 2.4 years, the risk of MACCE was significantly higher in patients with elevated Lp(a) levels than those with normal Lp(a) levels in both overall population (13.0% vs. 11.4%; adjusted hazard ratio [HR] 1.142, 95% confidence interval [CI] 1.009-1.293; P = 0.040) and propensity-matched cohorts (13.0% vs. 11.2%; HR 1.167, 95%CI 1.019-1.337; P = 0.026). Of note, the predictive value of Lp(a) levels on MACCE tended to be more evident in individuals >65 years or those with left main and/or three-vessel disease. On the contrary, elevated Lp(a) levels had almost no effect on clinical outcomes in patients ≤65 years (P interaction = 0.021) as well as those who had one- or two-vessel coronary artery disease (P interaction = 0.086).
Conclusion:
In CAD patients who underwent PCI, elevated Lp(a) levels were positively related to higher risk of MACCE at 2.4-year follow-up, especially in patients >65 years and those with left main and/or three-vessel disease.
Registration Number:
not applicable.
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