Impact of Lipoprotein(a) concentrations on long-term cardiovascular outcomes in patients undergoing percutaneous coronary intervention: A large cohort study |
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| Affiliation: | 1. Human Performance Laboratory, Department of Kinesiology, James Madison University, 261 Bluestone Dr MSC 2302, Harrisonburg, VA, 22807, USA;2. Department of Kinesiology, James Madison University, 261 Bluestone Dr. MSC 2302, Harrisonburg, VA, 22807, USA;1. Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan;2. Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;3. Department of Medicine, Chung Shan Medical University, Taichung, Taiwan;4. Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;5. Translational Research Institute Adventhealth, Florida, USA;6. Customer Delivery, Data Science Platform, Broad Institute of MIT and Harvard, Cambridge, MA 02412, USA;1. Institute for Community Medicine, University Medicine Greifswald, Germany;2. Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Germany;3. Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany;4. German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Greifswald, Germany;5. German Center for Diabetes Research (DZD), Partner site Greifswald, Greifswald, Germany;1. Center for Non-communicable Disease Management, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children''s Hospital, Capital Medical University, National Center for Children''s Health, Beijing, China;2. Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China;3. Capital Institute of Pediatrics, Beijing, China;4. Key Laboratory of Major Diseases in Children, Ministry of Education, China |
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| Abstract: | Background and aimsTill now, the prognostic value of lipoprotein(a) [Lp(a)] in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) remains controversial. We therefore conducted this study to evaluate the effect of Lp(a) levels on clinical outcomes in this population.Methods and resultsA total of 10,059 CAD patients who underwent PCI were prospectively enrolled in this cohort study, of which 6564 patients had Lp(a) ≤30 mg/dl and 3495 patients had Lp(a) > 30 mg/dl. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, stroke or unplanned revascularization. Multivariate Cox regression analysis and propensity-score matching analysis were performed. After propensity-score matching, 3449 pairs of patients were identified, and post-matching absolute standardized differences were <10% for all the covariates. At 2.4 years, the risk of MACCE was significantly higher in patients with elevated Lp(a) levels than those with normal Lp(a) levels in both overall population (13.0% vs. 11.4%; adjusted hazard ratio [HR] 1.142, 95% confidence interval [CI] 1.009–1.293; P = 0.040) and propensity-matched cohorts (13.0% vs. 11.2%; HR 1.167, 95%CI 1.019–1.337; P = 0.026). Of note, the predictive value of Lp(a) levels on MACCE tended to be more evident in individuals >65 years or those with left main and/or three-vessel disease. On the contrary, elevated Lp(a) levels had almost no effect on clinical outcomes in patients ≤65 years (P interaction = 0.021) as well as those who had one- or two-vessel coronary artery disease (P interaction = 0.086).ConclusionIn CAD patients who underwent PCI, elevated Lp(a) levels were positively related to higher risk of MACCE at 2.4-year follow-up, especially in patients >65 years and those with left main and/or three-vessel disease.Registration numbernot applicable. |
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| Keywords: | Lipoprotein(a) Coronary artery disease Percutaneous coronary intervention Age Left main and/or three-vessel disease Clinical outcome ACS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" acute coronary syndrome Apo(a)" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" apolipoprotein(a) CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" confidence interval CTO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" chronic total occlusion HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" hazard ratio LDL-C" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" low-density lipoprotein cholesterol Lp(a)" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" lipoprotein(a) MACCE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" major adverse cardiovascular and cerebrovascular event MI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" myocardial infarction PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" percutaneous coronary intervention |
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