Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea.
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
JACC Cardiovasc Interv. 2021 Sep 27;14(18):2059-2068. doi: 10.1016/j.jcin.2021.07.042.
This study evaluated the association between elevated levels of lipoprotein(a) [Lp(a)] and risk of recurrent ischemic events in patients who underwent percutaneous coronary intervention (PCI).
Elevated levels of Lp(a) have been identified as an independent, possibly causal, risk factor for atherosclerotic cardiovascular disease in a general population study.
A prospective single-center registry was used to identify 12,064 patients with baseline Lp(a) measurements who underwent PCI between 2003 and 2013. The primary outcomes were a composite of cardiovascular death, spontaneous myocardial infarction, and ischemic stroke.
From the registry, 3,747 (31.1%) patients had high Lp(a) (>30 mg/dL) and 8,317 (68.9%) patients had low Lp(a) (≤30 mg/dL). During a median follow-up of 7.4 years, primary outcomes occurred in 1,490 patients, and the incidence rates of primary outcomes were 2.0 per 100 person-years in the high-Lp(a) group and 1.6 per 100 person-years in the low-Lp(a) group (adjusted hazard ratio [aHR]: 1.17; 95% confidence interval [CI]: 1.05-1.30; P = 0.004). Increased risk of recurrent ischemic cardiovascular events in the high-Lp(a) group was consistent in various subgroups including patients receiving statin treatment at discharge (aHR: 1.18; 95% CI: 1.03-1.34; P = 0.011). In addition, the risk of repeated revascularization was significantly higher in the high-Lp(a) group (aHR: 1.13; 95% CI: 1.02-1.25; P = 0.022).
Elevated levels of Lp(a) were significantly associated with the recurrent ischemic events in patients who underwent PCI. This study provides a rationale for outcome trials to test Lp(a)-lowering therapy for secondary prevention in patients undergoing PCI.
本研究评估了脂蛋白(a)[Lp(a)]水平升高与经皮冠状动脉介入治疗（PCI）患者复发性缺血事件风险之间的关系。
在一项针对普通人群的研究中，脂蛋白(a)水平升高已被确定为动脉粥样硬化性心血管疾病的一个独立的、可能是因果关系的危险因素。
使用前瞻性单中心登记处，确定了 2003 年至 2013 年间接受 PCI 的基线脂蛋白(a)测量值为 12064 名患者。主要结局为心血管死亡、自发性心肌梗死和缺血性卒中的复合终点。
从登记处中，3747 名（31.1%）患者的脂蛋白(a)较高（>30mg/dL），8317 名（68.9%）患者的脂蛋白(a)较低（≤30mg/dL）。在中位随访 7.4 年期间，主要结局在 1490 名患者中发生，高脂蛋白(a)组的主要结局发生率为每 100 人年 2.0 例，低脂蛋白(a)组为每 100 人年 1.6 例（调整后的危险比[aHR]：1.17；95%置信区间[CI]：1.05-1.30；P=0.004）。在包括出院时接受他汀类药物治疗的患者在内的各种亚组中，高脂蛋白(a)组的复发性缺血性心血管事件风险增加是一致的（aHR：1.18；95%CI：1.03-1.34；P=0.011）。此外，高脂蛋白(a)组的再次血运重建风险显著升高（aHR：1.13；95%CI：1.02-1.25；P=0.022）。
脂蛋白(a)水平升高与接受 PCI 的患者的复发性缺血事件显著相关。这项研究为临床试验提供了依据，以检验在接受 PCI 的患者中进行脂蛋白(a)降低治疗的二级预防效果。
