Abstract 15093: Serum Apolipoprotein-A2 Levels Are a Stronger Predictor of the Residual Cardiovascular Event Risk After Percutaneous Coronary Intervention

Abstract

Introduction and Aim: Apolipoprotein-A2 (apoA2) is the second major apolipoprotein that constitutes high-density lipoprotein cholesterol (HDL-C) particles, following apolipoprotein-A1 (apoA1). HDL-C can be divided into two main subfractions: those containing both apoA1 and apoA2, and those containing only apoA1. It is believed that HDL-C particles with apoA2 exhibit superior functionality in lipid metabolism compared to those without apoA2. However, the clinical impact of apoA2 on future cardiovascular events in patients who have undergone percutaneous coronary intervention (PCI) remains unclear. The aim of our study is to test the hypothesis that apoA2 would be a stronger predictor of residual cardiovascular risk compared to other apolipoproteins in the statin era. Methods: We examined 638 patients who underwent PCI with a second-generation drug-eluting stent for acute or chronic coronary syndrome and had their apolipoproteins measured between 2016 and 2021 (median follow-up period of 17.7 months). The patients were divided into two groups based on the median serum apoA2 values. We assessed the incidence of major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal acute coronary syndrome, ischemic stroke, exacerbation of heart failure, or target vessel revascularization. Results: A total of 563 patients (88%) received statin treatment, and the median serum low-density lipoprotein cholesterol was 93 mg/dL. A total of 138 patients (21.6%) experienced MACEs, and Kaplan-Meier analysis revealed that the lower apoA2 group had a significantly higher incidence of MACEs compared to the higher apoA2 group (23.6% vs. 19.7%, p=0.036). However, the other apolipoproteins, including apolipoprotein-A1, B, C2, C3, or E, showed no significant difference in MACEs. Multivariate Cox hazard analysis indicated that apoA2 was an independent predictor of MACEs (hazard ratio 1.51; 95% confidence interval 1.06-2.14, p = 0.022). Furthermore, apoA2 levels exhibited the strongest inverse association with high-sensitivity C-reactive protein levels (ρ= -0.48, p<0.0001). Conclusions: Serum apoA2 level may be the strongest predictor of residual cardiovascular event risk after PCI among apolipoproteins.