Impact of lipoprotein(a) on long-term outcomes after percutaneous coronary intervention in patients with reduced low-density lipoprotein cholesterol

Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (1): 147-153     DOI: 10.31083/j.rcm.2020.01.5101 Impact of lipoprotein(a) on long-term outcomes after percutaneous coronary intervention in patients with reduced low-density lipoprotein cholesterol Yuhong Liu1, Zhihuan Zeng1, Xing Yu1, Tudi Li1, Yusi Yao1, Rong Chen1, Jianyi Zheng1, *() 1 Vasculocardiology Department, The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province 510080, P. R. China Abstract:

The purpose of this study is to investigate the effect of lipoprotein(a) level on long-range prognosis after Percutaneous Coronary Intervention (PCI) in patients with low-density lipoprotein cholesterol (LDL-C) goal attainment. In this retrospective study, 350 patients in Coronary artery disease (CAD) with LDL-C less than 1.8 mmol/L were enrolled in the Guangdong Institute of Cardiovascular Diseases from January 2011 to December 2013. Follow-up was 1 year after PCI. According to the median value of the study population based on Lp(a), the patients were assigned to the high-level group and low-level group. The clinical data of the 2 groups were collected. We compared the baseline data between the 2 groups and the incidence rate of major cardiovascular events. After statistical analysis, the gender composition, hypertension, diabetes, and age of the patients between the 2 groups were similar, and the distinction was not significant. There was no significant distinction in cardio-vascular death, ischemic stroke, and recurrent myocardial infarction between the 2 groups, but the incidence of revascularization was higher in the high-level group (P < 0.05). High Lp(a) level predicts an increased incidence of revascularization of patients in CAD with LDL-C less than 1.8 mmol/L after PCI.

Submitted:  01 December 2019      Accepted:  17 March 2020      Published:  30 March 2020      Fund: 
2017QTLXXM28/"innovative and strong university" project of Guangdong Pharmaceutical University *Corresponding Author(s):  Jianyi Zheng     E-mail:  czhengjammy@163.com Service E-mail this article Add to citation manager E-mail Alert RSS Articles by authors Yuhong Liu    Zhihuan Zeng    Xing Yu    Tudi Li    Yusi Yao    Rong Chen    Jianyi Zheng   

Figure 1.  The study flow chart. The inclusion and exclusion criteria, grouping and primary clinical endpoints of the study population were provided. Abbreviation: Lp(a): Lipoprotein(a), PCI: Percutaneous Coronary Intervention, LDL-C: low-density lipoprotein cholesterol, GFR: estimated glomerular filtration rate

Table 1.  Comparison of the Baseline Characteristics among Patients

Low-Lp(a)High- Lp(a)Variable(< 118 mmol/L)(≥ 118 mmol/L)P valuen = 174n = 176Male144 (82.8%)138 (78.4%)0.304Current smoker*79 (45.2%)59 (33.5%)0.023Hypertension100 (57.5%)104 (59.4%)0.758Diabetes mellitus49 (28.2%)54 (30.7%)0.604Acute myocardial infarction25 (14.4%)36 (20.4%)0.133Statin157 (90.2%)168 (95.5%)0.059ACEI/ARB142 (81.6%)152 (86.4%)0.225BETA150 (86.2%151 (85.8%)0.911Aspirin174 (100%)176 (100%)-Clopidogrel174 (100%)176 (100%)-Left main disease*21 (12.1%)36 (20.45%)0.033Three vessel lesions42 (24.1%)51 (29.0%)0.305

Table 2.  Comparison of baseline counting data among Patients

Low-Lp(a)High-Lp(a)Variable(< 118 mmol)(≥ 118 mmol/L)P valuen = 174n = 176Age (yrs) (mean ± SD)63.35 ± 10.6763.63 ± 11.000.809SBP126.51 ± 17.74130.03 ± 18.120.07DBP76.32 ± 11.0474.50 ± 11.010.127HR71.88 ± 10.9672.16 ± 11.730.824creatinine84.85 ± 21.7087.32 ± 23.620.31albumin*36.52 ± 4.7135.49 ± 4.690.045CHO3.24 ± 0.873.19 ± 0.710.573TG#(0.17, 1.82)(0.80, 1.43)0.063HDLC0.92 ± 0.370.87 ± 0.250.09LDLC1.46 ± 0.261.48 ± 0.240.425HBA1C6.50 ± 1.206.51 ± 1.470.958LVEF61.03 ± 11.9659.69 ± 13.420.379

Table 3.  Comparison of clinical outcomes between two groups

Low-Lp(a)High-Lp(a)Variable(< 118 mmol)(≥ 118 mmol/L)P valuen = 174n = 176Cardio-vascular death4 (2.2%)6 (3.4%)0.53Recurrent myocardial infarction3 (1.7%)6 (3.4%)0.31Ischemic stroke2 (1.1%)2 (1.1%)0.99Revascularization*12 (6.9%)24 (13.3%)0.031In-stent restenosis1 (0.6%)3 (1.7%)0.623

Figure 2.  Comparison of primary clinical endpoints between 2 groups. The x-axis represented 5 clinical endpoints, which included cardio-vascular death (A), recurrent myocardial infarction (B), ischemic stroke (C), revascularization (D) and in-stent restenosis (E). Patients in each endpoint event were assigned to high-Lp (a) group (≥118mmol/L) and low-Lp (a) group (<118mmol/L), which were shown as "red" and "blue" respectively.

Table 4.  Univariate and multivariate p value and ORs of clinical outcomes

CharacteristiesTVR group
(n = 36)Non-TVR group
(n = 314) Univariate
OR (95%CI)P value Multivariate
OR (95%CI)P valueCategorical dataMale29 (80.6%)253 (80.6%)1.331 (0.598-2.961)0.484————Current smoker17 (47.2%)121 (38.5%)1.278 (0.648-2.519)0.479————Diabetes mellitus1*/2*16 (44.4%)87 (27.7%)1.905 (1.168-3.331)0.0381.783 (1.053-3.021)0.044Statin36 (100%)289 (92.0%)——0.998————ACEI/ARB30 (83.3%)264 (84.1%)0.682 (0.295-1.577)0.368————BETA30 (83.3%)271 (86.3%)0.567 (0.243-1.322)0.189————Aspirin36 (100%)314 (100%)————————Clopidogrel36 (100%)314 (100%)————————Left main disease6 (16.7%)51 (16.2%)0.960 (0.382-2.413)0.93————High level of Lp(a)1*/2*24 (66.7%)152 (48.4%)2.502 (1.188-4.967)0.0212.340 (1.140-4.803)0.028Continuous data (mean ± SD)Age (yrs)62.54 ± 9.4963.61 ± 10.980.991 (0.961-1.022)0.568————SBP1*135.68 ± 16.61126.63 ± 18.161.076 (1.032-1.124)0.042——0.083DBP73.32 ± 10.0675.66 ± 11.150.980 (0.949-1.012)0.217————creatinine81.46 ± 20.8386.65 ± 22.870.989 (0.973-1.005)0.183————albumin36.00 ± 4.6736.01 ± 4.740.999 (0.928-1.076)0.987————CHO3.01 ± 0.413.25 ± 0.830.568 (0.305-1.060)0.075————TG1.22 ± 0.711.61 ± 2.190.835 (0.597-1.167)0.291————LDL-C1.46 ± 0.241.47 ± 0.250.749 (0.205-2.734)0.662————HDL-C1*0.83 ± 0.210.95 ± 0.330.380 (0.096-0.992)0.047——0.125HBA1C6.45 ± 1.636.52 ± 1.310.961 (0.720-1.282)0.787————LVEF60.81 ± 12.3360.30 ± 12.821.003 (0.974-1.033)0.831———— [1] Boullier, A.,Walters-Laporte, E.,Hamon, M.,Tailleux, A.,Amant, C.,Amouyel, P.,Fruchart, J.,Bertrand, M.,Duriez, P. 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