Department of Cardiology State Key Laboratory of Cardiovascular Disease FuWai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Cardiology XuanWu Hospital Capital Medical University Beijing China.
J Am Heart Assoc. 2020 Feb 4;9(3):e014581. doi: 10.1161/JAHA.119.014581. Epub 2020 Jan 30.
Background Although several studies have indicated that lipoprotein(a) is a useful prognostic predictor for patients following percutaneous coronary intervention (PCI), previous observations have somewhat been limited by either small sample size or short-term follow-up. Hence, this study aimed to evaluate the impact of lipoprotein(a) on long-term outcomes in a large cohort of stable coronary artery disease patients after PCI. Methods and Results In this multicenter and prospective study, we consecutively enrolled 4078 stable coronary artery disease patients undergoing PCI from March 2011 to March 2016. They were categorized according to both the median of lipoprotein(a) levels and lipoprotein(a) values of <15 (low), 15 to 30 (medium), and ≥30 mg/dL (high). All patients were followed up for occurrence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average of 4.9 years of follow-up, 315 (7.7%) cardiovascular events occurred. The events group had significantly higher lipoprotein(a) levels than the nonevents group. Compared with the low lipoprotein(a) group, Kaplan-Meier analysis showed that the high lipoprotein(a) group had a significantly lower cumulative event-free survival rate, and multivariate Cox regression analysis further revealed that the high lipoprotein(a) group had significantly increased cardiovascular events risk. Moreover, adding continuous or categorical lipoprotein(a) 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 lipoprotein(a) levels could be associated with a poor prognosis after PCI in stable coronary artery disease patients, suggesting that lipoprotein(a) measurements may be useful for patient risk stratification before selective PCI.
背景 虽然几项研究表明脂蛋白(a) 是经皮冠状动脉介入治疗 (PCI) 后患者的一种有用的预后预测指标，但之前的观察结果受到样本量小或随访时间短的限制。因此，本研究旨在评估脂蛋白(a) 对接受 PCI 的稳定型冠状动脉疾病患者的长期预后的影响。
方法和结果 在这项多中心前瞻性研究中，我们连续纳入了 2011 年 3 月至 2016 年 3 月接受 PCI 的 4078 例稳定型冠状动脉疾病患者。根据脂蛋白(a)水平的中位数和脂蛋白(a)值将他们分为<15（低）、15-30（中）和≥30mg/dL（高）。所有患者均随访心血管事件的发生情况，包括心血管死亡、非致死性心肌梗死和中风。在平均 4.9 年的随访期间，发生了 315 例（7.7%）心血管事件。事件组的脂蛋白(a)水平明显高于无事件组。与低脂蛋白(a)组相比，Kaplan-Meier 分析显示高脂蛋白(a)组的累积无事件生存率显著降低，多变量 Cox 回归分析进一步显示高脂蛋白(a)组的心血管事件风险显著增加。此外，将连续或分类脂蛋白(a) 添加到 Cox 模型中可显著提高 C 统计量、净重新分类和综合鉴别力。
结论 本研究数据证实，在稳定型冠状动脉疾病患者中，高脂蛋白(a)水平与 PCI 后不良预后相关，这表明脂蛋白(a)测量可能有助于选择性 PCI 前的患者风险分层。
