Abstract
Objective: The aim of this study was to investigate the effect of Lipoprotein-a [Lp(a)] on Coronary Revascularizaton (CR) on one year follow up in patients with Acute Coronary Syndrome (ACS) after the first Percutaneous Coronary Intervention (PCI). Method: A retrospective study was designed. A total of 475 patients that underwent their first PCI treatment due to ACS between January 2016 and December 2017 were recruited and followed for one year at the Zhongda Hospital, China. The clinical end point after first PCI was prevalence of Major Adverse Cardiovascular Events (MACE) including nonfatal Myocardial Infarction (MI), cardiovascular death, ischemic stroke and Coronary Revascularization (CR). According to the cut point of Lp(a), participants were divided into low Lp(a) subgroup (Lp(a) mg/L) and high Lp(a) subgroup (Lp(a) ≥ 300 mg/L). Furthermore, based on baseline Low Density Lipoprotein Cholesterol (LDL-C) level, participants were divided into low LDL-C (LDL-C mmol/L) and high LDL-C (LDL-C ≥ 1.8 mmol/L) subgroups. Results: The number of prevalence of CR was higher with elevated serum Lp(a) in both low LDL-C subgroup and high LDL-C subgroup, and was significantly different in both the low LDL-C subgroup and high LDL-C subgroup (p = 0.009 and p = 0.006, respectively). Multivariate Cox-hazard regression analysis for CR showed increase in serum LDL-C and Lp(a) increased prevalence of CR by 1.514 and 1.002 folds respectively. Furthermore, Kaplan-Meier cumulative survival curves showed that increased prevalence of CR within one year after first PCI in patients with high Lp(a) [log rank p = 0.000]. Conclusion: Baseline increase of serum LDL-C and Lp(a) significantly increases the prevalence of CR after first PCI within one year. It indicates that after PCI treatment, in patient with serum LDL-C and Lp(a) elevation, treatment with high-dose statin therapy or PCSK9 inhibitors may alleviate the adverse effects imposed by Lp(a) elevation.
Highlights
Hyperlipidemia, especially high serum level of low density lipoprotein-cholesterol (LDL-C) has been well documented as an important risk factor of atherosclerosis and its manifestation of atherosclerotic cardiovascular diseases (ASCVD) [1]
Feb. 21, 2020 that after Percutaneous Coronary Intervention (PCI) treatment, in patient with serum Low Density Lipoprotein Cholesterol (LDL-C) and Lp(a) elevation, treatment with high-dose statin therapy or PCSK9 inhibitors may alleviate the adverse effects imposed by Lp(a) elevation
Some epidemiological studies show that, target LDL-C level has been achieved by statin therapy, residual cardiovascular risk such as coronary restenosis after Percutaneous Coronary Intervention (PCI) is still very high [3] [4]
Summary
Hyperlipidemia, especially high serum level of low density lipoprotein-cholesterol (LDL-C) has been well documented as an important risk factor of atherosclerosis and its manifestation of atherosclerotic cardiovascular diseases (ASCVD) [1]. Some epidemiological studies show that, target LDL-C level has been achieved by statin therapy, residual cardiovascular risk such as coronary restenosis after Percutaneous Coronary Intervention (PCI) is still very high [3] [4]. It suggests that other risk factors besides LDL-C could play a contributory role in the progression and recurrence of ACS after PCI, and identifying those potential risk factors would be beneficial for further improving cardiovascular outcome [3] [4]. Its cut-off value of significant risk for the Caucasians was recommended as 500 mg/L, whereas for the Chinese population, it is 300 mg/L considering far lower than the Caucasians [9] [10]
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