Correlation Between Serum Lipoprotein (a) And Coronary Artery Severity And Long-term Prognosis In Patients With Coronary Heart Disease

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Lipoprotein(a)levels are associated with coronary severity in Chinese patients underwent percutaneous coronary intervention coronary artery disease.Receiver operating characteristics(ROC)curves were constructed to document the predictive value of Lp(a)for high SS.Subgroup analysis showed that Lp(a)level had significant interaction with age and gender,the correlation between Lp(a)and SS score was stronger in the subgroup with age?55 years and female.BackgroundLipoprotein(a)(Lp(a))is a genetic low density lipoprotein,which is stable in plasma and can promote the development of atherosclerosis and thrombosis.Percutaneous coronary intervention(PCI)is an important method for revascularization of coronary atherosclerotic heart disease.SYNTAX score(SS)is a scoring system formed according to the anatomical structure of coronary artery and the degree of lesion,and an important indicator for assessing the severity of coronary artery in patients with PCI.Previous studies have shown that increased Lp(a)level is an independent risk factor for clinical events in patients with a variety of cardiovascular diseases.However,few studies have explored the relationship between Lp(a)levels and coronary artery severity in patients with coronary heart disease after PCI.ObjectivesThe purpose of this study was to explore the predictive value of serum Lp(a)level with coronary artery severity in patients with coronary heart disease after PCI using the STNYAX scoring system.MethodsThis study is the second analysis of a large single-center,prospective,observational cohort study that enrolled 10,724 patients with coronary heart disease who underwent PCI in Fuwai hospital from January to December 2013.This analysis included only patients with complete baseline Lp(a)data and excluded patients with previous myocardial infarction or coronary intervention or coronary artery bypass grafting.The serum Lp(a)level was measured by immunoturbidimetry at admission,and the subjects were divided into three groups:high,medium and low according to Lp(a).According to the SS scoring system,the severity of coronary artery in each patient was calculated,and SS?23 was defined as moderate to severe coronary artery lesions.To compare the difference of SS score between different Lp(a)level groups and the proportion of patients with moderate to severe coronary artery disease.Scatter plots were used to describe the correlation between Lp(a)level and SS score,and univariate and multivariate Logsitc regression was used to analyze the value of Lp(a)in predicting moderate to severeResultsThis study eventually included 6714 patients.Subjects enrolled in the study were divided into three groups according to Lp(a)triad method:low group:Lp(a)? 10.59mg/dL(2238 cases),middle group:10.59mg/dL<Lp(a)<30.55mg/dL(2238 cases),and high group:Lp(a)? 30.55mg/dL(2238 cases).The comparison of baseline data showed that with the increase of Lp(a)level,the proportion of women was higher,the proportion of patients with multiple vascular diseases and right coronary lesions was higher,the age was older,and the dyslipidemia was more obvious.The proportion of people with diabetes and smoking decreased gradually.With the increase of Lp(a)level,the mean SS score and the proportion of middle to high SS score increased significantly.Correlation analysis of scatter plot showed that Lp(a)level was significantly correlated with SS score(r=0.062,P<0.001).In the univariate Logisitic analysis,Lp(a)was strongly correlated with medium to high SS scores(P=0.002).Multivariate Logisitic regression analysis showed that Lp(a)was an independent predictor of medium to high SS score(OR:1.004,95%CI:1.001-1.006,P=0.009).The area undert the ROC curves(AUC)indicated a well discriminatory power of plasma fibrinogen(AUC=0.597,95%CI 0.514-0.559,P=0.001)in predicting the severith of coronary atherosclerosis,and the optimal cut-off value was 16.24 mg/dL(sensitivity of 59%and specificity of 47%).ConclusionsSerum Lp(a)level in patients with coronary artery disease after percutaneous coronary intervention is significantly correlated with coronary severity,and Lp(a)may be a usefull biomarker in predicting medium to high coronary severity.Part ? Predictive value of lipoprotein(a)in patients with three-vessel Coronary heart diseaseBackgoundLipoprotein(a)(Lp(a))is a genetically determined independent risk factor for atherosclerotic vascular disease.Previous studies have shown that serum lipoprotein(a)level is closely related to the clinical prognosis of patients with acute myocardial infarction and stable coronary heart disease.However,the predictive value of serum lipoprotein(a)in patients with three-vessel disease(TVD)of severe coronary heart disease has not been fully clarified.ObjectivesThe purpose of this study was to explore the relationship between serum lipoprotein(a)level and long-term prognosis of patients with TVD,in order to evaluate the predictive value of lipoprotein(a)in patients with severe coronary heart disease.MethodsA total of 6,175 consecutive patients with angiographically confirmed TVD and available baseline Lp(a)data were included in this study.Based on the median level of Lp(a)at admission,the patient was divided into two sub-groups.Primary end point was major adverse cardiovascular events(MACE),of which all-cause death,myocardial infarction and unplanned revascularization were all included.This study is a secondary analysis of a large single-center,prospective,observational cohort study.From April 2004 to February 2011,8,943 patients with coronary heart disease with TVD who were admitted to Fuwai hospital were continuously included.The primary end point was all-cause death,the secondary end point included cardiac death,major adverse cardiac events,a composite end point of death,non-fatal myocardial infarction,and unplanned revascularization),and the individual components of the composite.Only patients with complete baseline lipoprotein(a)data were included in this analysis,and the analysis population could be divided into low Lp(a)group and high Lp(a)group according to the median Lp(a)value.Survival curve was used to compare the cumulative incidence of long-term MACE and myocardial infarction between the two groups.Hazard ratio(HR)and 95%confidence interval(CI)were calculated using the multivariate Cox proportional risk model,and subgroup analysis was performed.ResultsAfter excluding patients with missing serum lipoprotein(a)data,a total of 6,175 patients with TVD were finally enrolled in the cohort study.According to the median value of Lp(a),it can be divided into two groups:low Lp(a)group:Lp(a)?3.76 mg/dl(3088 cases),high Lp(a)group:Lp(a)>13.76 mg/dl(3087 cases).Compared with baseline data,dyslipidemia was more in the high Lp(a)group.During the whole follow-up period(median follow-up time was 6.2 years),1433 patients developed MACE,among which 804 patients died.Compared with the low Lp(a)group,the incidence of MACE and MI in the high Lp(a)group was significantly increased(P<0.05).There was no significant difference in the incidence of all-cause death or unplanned revascularization between the two groups.Multivariate analysis showed that after adjusting for confounding factors,high Lp(a)value was significantly correlated with the occurrence of MACE(HR:1.167,95%CI:1.044-1.305,P=0.007)and MI(HR:1.472,95%CI:1.148-1.887,P=0.002).Subgroup analysis showed that there was significant interaction between Lp(a)and gender(interaction P=0.002),in other words,in the female population the incidence of MACE was significantly higher in the high Lp(a)group than low Lp(a)group(adjusted HR:1.666,95%CI:1.290-2.153,adjusted P<0.001).In male patients,Lp(a)tended to correlate with MACE(adjusted HR:1.070,95%CI:0.944-1.212,adjusted P=0.233).In other subgroups,the relationship between Lp(a)level and MACE was basically consistent(all interaction P values were>0.05).Conclusions(1)in patients with severe coronary heart disease with TVD,multivariate Cox regression analysis model was used to adjust confounding factors,and it was found that baseline high Lp(a)level was significantly correlated with long-term MACE and myocardial infarction,and was an independent predictor of MACE and myocardial infarction;(2)the relationship between high Lp(a)level and MACE and myocardial infarction was influenced by gender,while in other subgroup analyses,this relationship was basically consistent.Part ? Association of Plasma Lipoprotein(a)with Long-term Adverse Events in Patients with Chronic Kidney Disease Who Underwent Percutaneous Coronary InterventionBackgroundLipoprotein(a)(Lp(a))is a genetically determined independent risk factor for atherosclerotic vascular disease.Chronic kidney disease is an independent risk factor for cardiovascular disease.Previous studies have shown that serum lipoprotein(a)level is closely related to the clinical prognosis of patients with coronary heart disease.However,the prognostic value of serum lipoprotein(a)in patients with chronic kidney disease(CKD)combined with coronary heart disease(PCI)has not been fully clarified.ObjectivesThe purpose of this study was to explore the relationship between serum lipoprotein(a)level and the clinical prognosis of patients with coronary heart disease complicated with chronic kidney disease treated with PCI,in order to evaluate the predictive value of lipoprotein(a)in CKD in this special population.MethodsThis study is a secondary analysis of a large single-center,prospective,observational cohort study.This cohort study enrolled 10724 patients with coronary heart disease who underwent PCI at Fuwai hospital from January to December 2013.The primary end point was all-cause death,and the secondary end point included cardiac death,hemorrhage,major adverse cardiac and cerebrovascular events,a composite end point including death,nonfatal myocardial infarction,nonfatal stroke,and unplanned revascularization),and individual component of the composite.Only patients diagnosed with CKD and with complete baseline lipoprotein(a)data were included in this analysis.According to the median value of Lp(a),the analysis could be divided into low Lp(a)group and high Lp(a)group.Differences in primary and secondary endpoints were compared between the two groups.KM curve was used to compare the incidence of MACE and other clinical events in the two groups.Hazard ratio(HR)and 95%CI confidence interval(CI)were calculated by Cox proportional risk model.ResultsAfter excluding patients with missing serum lipoprotein(a)data,a total of 427 CKD patients treated with PCI were enrolled in this study.According to the median Lp(a)level of the analyzed population(median=217.8 mg/L),patients were divided into two groups:high Lp(a)group(214 cases)and low Lp(a)group(213 cases).At baseline,dyslipidemia was more in the high Lp(a)group.The follow-up time was 2 years.The incidence of MACCE,cardiac death,myocardial infarction,stent thrombosis and bleeding in the high Lp(a)group was higher than that in the low Lp(a)group(P<0.05).There was no statistical difference between the two groups in the incidence of unplanned revascularization and ischemic stroke.Scatter plot correlation analysis showed that Lp(a)level on admission was positively correlated with the level of hypersensitive C-reactive protein(r2=0.03,P<0.001).Survival analysis showed that the incidence of MACCE in the high Lp(a)group was significantly higher than that in the low Lp(a)group(23.0%vs.15.4%,P=0.047).Meanwhile,according to the bleeding defined by BARC,the incidence of bleeding in the high Lp(a)group was significantly higher than that in the low Lp(a)group(8.9%vs.4.2%,P=0.049).Multivariate analysis found that Lp(a)was an important independent predictor of MACCE(HR:1.64,95%CI:1.04-2.58,P=0.032)and hemorrhage(HR:2.29,95%CI:1.01-5.15,P=0.046).Conclusions(1)high Lp(a)is associated with increased risk of cardiac death,MACCE,myocardial infarction,revascularization,ischemic stroke and bleeding.(2)after adjusting for confounding factors by multivariate Cox regression model,high Lp(a)was an independent predictor of MACCE and hemorrhage in 2 years.(3)Lp(a)was positively correlated with hsCRP(r2=0.03,P<0.001).