Impact of Lipoprotein (a) on Long-Term Outcomes in Patients with Coronary Artery Disease Treated with Statin After a First Percutaneous Coronary Intervention.
OBJECTIVE
Cardiovascular risk persists despite intensive lipid lowering therapy using statins. Serum levels of lipoprotein (a) [Lp(a)] can be a residual cardiovascular risk for adverse events. Aim of the present study was to evaluate the impact of Lp(a) on long-term clinical outcomes in patients treated with statin after percutaneous coronary intervention.


METHODS
We prospectively enrolled 3507 consecutive CAD patients who underwent a first percutaneous coronary intervention (PCI) between 1997 and 2011 at our institution. We identified 1768 patients (50.4%) who had treated with statin during PCI. Eligible 1336 patients were stratified to two groups according to Lp(a) levels (median Lp (a) 21.5 mg/dL). The primary outcome was major adverse cardiac events (MACE) including cardiac death and non-fatal acute coronary syndrome.


RESULTS
MACE occurred 144 (10.8%) including 34 (2.5%) cardiac death and 110 (8.7%) non-fatal ACS during median follow-up period of 1920 days. The cumulative rate of MACE was significantly higher in group with high Lp(a) group (log-rank p=0.0460). Multivariate Cox regression analysis showed a significant correlation between Lp (a) levels treated as a natural logarithm-transformed continuous variable and increased MACE (adjusted HR for MACE 1.28, 95%CI 1.04-1.58, p=0.0184)Conclusion: Elevated levels of Lp(a) is significantly associated with long-term adverse clinical outcomes among CAD patients who received statin therapy after PCI.
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Satoru
S
Suwa
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Manabu
M
Ogita
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Katsumi
K
Miyauchi
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Taketo
T
Sonoda
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Hirokazu
H
Konishi
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Shuta
S
Tsuboi
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Hideki
H
Wada
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Ryo
R
Naito
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Tomotaka
T
Dohi
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Takatoshi
T
Kasai
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Shinya
S
Okazaki
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Kikuo
K
Isoda
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Hiroyuki
H
Daida
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a)
Coronary artery disease; Lipoprotein (a); Percutaneous coronary intervention; Statin