Abstract 16718: Association of Elevated Lipoprotein A With Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Abstract

Background: Patients who undergo percutaneous coronary intervention (PCI) are at increased risk for subsequent cardiovascular (CV) events. Elevated lipoprotein A [Lp(a)] is associated with atherothrombotic disease; however, its role in risk stratification for patients with prior PCI is unknown. Methods: Patients with prior PCI were identified in the Mass General Brigham Lp(a) Registry, a retrospective cohort that included patients who had Lp(a) measured as part of routine care from 2000-2019 and excluded those with severe renal dysfunction (eGFR < 15 mL/min/m 2 , dialysis, or renal transplant) or a malignant neoplasm diagnosis (excepting non-melanoma skin cancers). Lp(a) percentile groups were derived as follows: 1st-50th (ref), 51st-70th, 71st-90th, 91st-100th. The primary outcome was a composite of CV death or myocardial infarction (MI). Results: A total of 2,389 patients with prior PCI were included with a median follow-up period of 12.8 years. Median age was 60 and 583 (24.4%) were women. Higher Lp(a) percentile group was associated with increased incidence of the primary outcome with patients in the 71 st -90 th percentile (112-215 nmol/L) having a HR of 1.39 (95% CI: 1.15-1.69, p = 0.001) and patients in the 91 st -100 th percentile (≥ 216 nmol/L) having a HR: 1.61 (95% CI: 1.26-2.06, p < 0.001). Findings remained significant after adjustment for age, sex, smoking, diabetes, chronic kidney disease, and insulin use with adjusted HR of 1.25 (95% CI: 1.03-1.53, p = 0.024) and adjusted HR of 1.63 (95% CI: 1.27-2.10, p < 0.001) for the 71 st -90 th and 91 st -100 th percentiles, respectively. A similar magnitude of association was observed in evaluating Lp(a) and CV death alone (Figure). Conclusions: Elevated Lp(a) is strongly and independently associated with increased risk of CV death or MI among patients with prior PCI in a stepwise manner that persists over time. Findings support the use of Lp(a) screening in patients with prior PCI to enhance risk stratification.