The Value Of Serum Lipoprotein (a) Level In Predicting Postoperative And Recurrent Cardiovascular Events In Patients With Stable Coronary Heart Disease

Background:Lipoprotein(a)[Lp(a)]is one of the most attractive and promising cardiovascular risk factors.A large number of studies have suggested that elevated plasma Lp(a)levels consequently play an important role in promoting cardiovascular disease(CVD)in primary prevention and predicting subsequent CVEs in secondary prevention.Several studies have also indicated that Lp(a)is a useful prognostic predictor for patients following percutaneous coronary intervention(PCI),however,the previous observations have somewhat been limited by either small sample size or short-term follow-up.This study,hence,aimed to evaluate the impact of Lp(a)on long-term outcomes in a large cohort of stable coronary artery disease(CAD)patients after PCI.Methods:In this multicenter and prospective study,we consecutively enrolled 4078 stable CAD patients undergoing PCI from March 2011 to March 2016.The baseline Lp(a)concentrations of all subjects were measured and then they were categorized according to both the median of Lp(a)levels and Lp(a)values of<15(low),15-30(medium)and?30 mg/dL(high).All patients were regularly followed-up for the occurrence of cardiovascular events(CVEs)including cardiovascular death,non-fatal myocardial infarction and stroke.Finally,the association between Lp(a)and CVEs were evaluated.Results:During an average of 4.9 years of follow-up,315(7.7%)CVEs occurred.The events group had significantly higher Lp(a)levels than non-events group.Compared with low Lp(a)group,Kaplan-Meier analysis showed that high Lp(a)group had significantly lower cumulative event-free survival rate and multivariate Cox regression analysis further revealed that high Lp(a)group had significantly increased CVEs risk(HR,2.1,95%CI:1.5-3.0,p<0.05).Moreover,adding continuous[?C:0.019(0.005-0.039),p=0.030]or categorical Lp(a)[AC:0.020(0.005-0.041),p=0.030]to the Cox model led to a significant improvement in C-statistic,net reclassification and integrated discrimination.Conclusions:With a large sample size and long-term follow-up,our data confirmed that high Lp(a)levels could be associated with a poor prognosis after PCI in stable CAD patients,suggesting that Lp(a)measurements may be useful for patients' risk stratification before selective PCI.Background:Although there have been mounting evidence suggesting the predictive role of lipoprotein(a)[Lp(a)]for cardiovascular risk,whether Lp(a)is a predictor for recurrent cardiovascular events(RCVEs)in patients with coronary artery disease(CAD)has not been established.This study,hence,aimed to examine the potential impact of Lp(a)on RCVEs in a real-world,large cohort of patients with the first cardiovascular event(CVE).Methods:In this multicenter,prospective study,7562 patients with angiography-diagnosed CAD who had experienced a first CVE were consecutively enrolled.Lp(a)concentrations of all subjects were measured at admission and then the participants were categorized according to Lp(a)tertiles(<8.88,8.89-22.44,?22.45 mg/dL).All patients were followed-up for the occurrence of RCVEs including cardiovascular death,non-fatal myocardial infarction and stroke.Kaplan-Meier and Cox proporthional hazard models were used to assess the association between Lp(a)and RCVEs.Results:During a mean follow-up of 61.45±19.57 months,680(9.0%)RCVEs occurred.The results showed that recurrent events group had significantly higher Lp(a)levels than non-events group(20.58 vs.14.95 mg/dL,p<0.001).Kaplan-Meier analysis indicated that Lp(a)tertile 2(p=0.001)and tertile 3(p<0.001)groups had significantly lower cumulative event-free survival rates compared with tertile 1 group.Moreover,multivariate Cox regression analysis further revealed that Lp(a)was independently associated with RCVEs risk[hazard ratio(HR):2.01,95%confidence interval(CI):1.45-2.85,p<0.001].Sensitivity analyses further demonstrated this association well.Subgroup analyses showed that the predictive role of Lp(a)for RCVEs was more evident in patients with previous stroke or in males.What's more,adding Lp(a)to the predicting model led to a slight but significant improvement in C-statistic[AC-statistic:0.021(0.003-0.037),p=0.019],net reclassification(6.8%,95%CI:1.3%-12.3%,p=0.010)and integrated discrimination(0.2%,95%CI:0.1%-0.6%,p=0.010).Conclusions:Our study showed that circulating Lp(a)concentration was indeed a useful predictor for the risk of RCVEs in real-world treated patients with CAD,providing additional information concerning the future clinical application of Lp(a).