Prognostic significance of elevated lipoprotein(a) in coronary artery revascularization patients.
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 х(2) 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.
Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Sung Woo
SW
Kwon
Byoung Kwon
BK
Lee
Bum-Kee
BK
Hong
Jong-Youn
JY
Kim
Eui-Young
EY
Choi
Ji Min
JM
Sung
Ji-Hyuck
JH
Rhee
Yoo Mi
YM
Park
Dae Won
DW
Ma
Hyemoon
H
Chung
Hee-Sun
HS
Mun
Sung-Joo
SJ
Lee
Jong-Kwan
JK
Park
Pil-Ki
PK
Min
Young Won
YW
Yoon
Se-Joong
SJ
Rim
Hyuck Moon
HM
Kwon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000639:trends; D011379:Prognosis; D012307:Risk Factors
D015415:Biomarkers; D017270:Lipoprotein(a)