Prognostic significance of elevated lipoprotein(a) in coronary artery revascularization patients

• Published in: International journal of cardiology 2013-09, Vol.167 (5), p.1990-1994
• Main Authors: Kwon, Sung Woo, Lee, Byoung Kwon, Hong, Bum-Kee, Kim, Jong-Youn, Choi, Eui-Young, Sung, Ji Min, Rhee, Ji-Hyuck, Park, Yoo Mi, Ma, Dae Won, Chung, Hyemoon, Mun, Hee-Sun, Lee, Sung-Joo, Park, Jong-Kwan, Min, Pil-Ki, Yoon, Young Won, Rim, Se-Joong, Kwon, Hyuck Moon
• Format: Article
• Language: English
• Subjects: Adult; Adverse cardiac events; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiovascular; Coronary artery disease; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Coronary artery revascularization; Coronary heart disease; Female; Follow-Up Studies; Heart; Humans; Lipoprotein(a); Lipoprotein(a) - blood; Male; Medical sciences; Middle Aged; Myocardial Revascularization - trends; Prognosis; Risk Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.05.007

Abstract Background Although lipoprotein(a) [Lp(a)] has been considered a cardiovascular risk factor for many years, there is a paucity of data in regard to the potential risk of elevated Lp(a) in symptomatic patients with CAD. Therefore, we sought to evaluate whether elevated Lp(a) is associated with worse outcome in symptomatic patients with coronary artery disease (CAD), and to clarify the prognostic value of Lp(a) in the era of coronary artery revascularization. Methods 6252 consecutive subjects (59.2% male, mean age 61.2 ± 11.2 years) suspected of having CAD underwent coronary angiography. Laboratory values for lipid parameters including Lp(a) were obtained on the day of coronary angiography. Baseline risk factors, coronary angiographic findings, length of follow-up, and major adverse cardiovascular events (MACE), including cardiac death and non-fatal myocardial infarction were recorded. Results Over a mean follow-up period of 3.1 ± 2.2 years, there were 100 MACE (56 cardiac deaths and 44 non-fatal myocardial infarctions), with an event rate of 1.6%. In multivariate Cox regression analysis, elevated Lp(a) was a significant predictor of MACE [hazard ratio 1.773 (95% confidence interval 1.194–2.634, p = 0.005)], and the addition of this factor to the model significantly increased the global х2 value over traditional risk factors and CAD (from 79.1 to 88.7, p = 0.003). Conclusions Elevated Lp(a) is an independent prognostic risk factor for cardiovascular events, and moreover, has incremental prognostic value in symptomatic patients with coronary artery revascularization.