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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (1): 147-153     DOI: 10.31083/j.rcm.2020.01.5101
Original Research Previous articles |
Impact of lipoprotein(a) on long-term outcomes after percutaneous coronary intervention in patients with reduced low-density lipoprotein cholesterol
Yuhong Liu1, Zhihuan Zeng1, Xing Yu1, Tudi Li1, Yusi Yao1, Rong Chen1, Jianyi Zheng1, *()
Vasculocardiology Department, The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province 510080, P. R. China
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Abstract:

The purpose of this study is to investigate the effect of lipoprotein(a) level on long-range prognosis after Percutaneous Coronary Intervention (PCI) in patients with low-density lipoprotein cholesterol (LDL-C) goal attainment. In this retrospective study, 350 patients in Coronary artery disease (CAD) with LDL-C less than 1.8 mmol/L were enrolled in the Guangdong Institute of Cardiovascular Diseases from January 2011 to December 2013. Follow-up was 1 year after PCI. According to the median value of the study population based on Lp(a), the patients were assigned to the high-level group and low-level group. The clinical data of the 2 groups were collected. We compared the baseline data between the 2 groups and the incidence rate of major cardiovascular events. After statistical analysis, the gender composition, hypertension, diabetes, and age of the patients between the 2 groups were similar, and the distinction was not significant. There was no significant distinction in cardio-vascular death, ischemic stroke, and recurrent myocardial infarction between the 2 groups, but the incidence of revascularization was higher in the high-level group (P < 0.05). High Lp(a) level predicts an increased incidence of revascularization of patients in CAD with LDL-C less than 1.8 mmol/L after PCI.

Key words:  Lipoprotein(a)      coronary artery disease      intervention     
Submitted:  01 December 2019      Accepted:  17 March 2020      Published:  30 March 2020     
Fund: 
2017QTLXXM28/"innovative and strong university" project of Guangdong Pharmaceutical University
*Corresponding Author(s):  Jianyi Zheng     E-mail:  czhengjammy@163.com

Cite this article: 

Yuhong Liu, Zhihuan Zeng, Xing Yu, Tudi Li, Yusi Yao, Rong Chen, Jianyi Zheng. Impact of lipoprotein(a) on long-term outcomes after percutaneous coronary intervention in patients with reduced low-density lipoprotein cholesterol. Reviews in Cardiovascular Medicine, 2020, 21(1): 147-153.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.01.5101     OR     https://rcm.imrpress.com/EN/Y2020/V21/I1/147

Figure 1.  The study flow chart. The inclusion and exclusion criteria, grouping and primary clinical endpoints of the study population were provided. Abbreviation: Lp(a): Lipoprotein(a), PCI: Percutaneous Coronary Intervention, LDL-C: low-density lipoprotein cholesterol, GFR: estimated glomerular filtration rate

Table 1.  Comparison of the Baseline Characteristics among Patients
Low-Lp(a)High- Lp(a)
Variable(< 118 mmol/L)(≥ 118 mmol/L)P value
n = 174n = 176
Male144 (82.8%)138 (78.4%)0.304
Current smoker*79 (45.2%)59 (33.5%)0.023
Hypertension100 (57.5%)104 (59.4%)0.758
Diabetes mellitus49 (28.2%)54 (30.7%)0.604
Acute myocardial infarction25 (14.4%)36 (20.4%)0.133
Statin157 (90.2%)168 (95.5%)0.059
ACEI/ARB142 (81.6%)152 (86.4%)0.225
BETA150 (86.2%151 (85.8%)0.911
Aspirin174 (100%)176 (100%)-
Clopidogrel174 (100%)176 (100%)-
Left main disease*21 (12.1%)36 (20.45%)0.033
Three vessel lesions42 (24.1%)51 (29.0%)0.305
Table 2.  Comparison of baseline counting data among Patients
Low-Lp(a)High-Lp(a)
Variable(< 118 mmol)(≥ 118 mmol/L)P value
n = 174n = 176
Age (yrs) (mean ± SD)63.35 ± 10.6763.63 ± 11.000.809
SBP126.51 ± 17.74130.03 ± 18.120.07
DBP76.32 ± 11.0474.50 ± 11.010.127
HR71.88 ± 10.9672.16 ± 11.730.824
creatinine84.85 ± 21.7087.32 ± 23.620.31
albumin*36.52 ± 4.7135.49 ± 4.690.045
CHO3.24 ± 0.873.19 ± 0.710.573
TG#(0.17, 1.82)(0.80, 1.43)0.063
HDLC0.92 ± 0.370.87 ± 0.250.09
LDLC1.46 ± 0.261.48 ± 0.240.425
HBA1C6.50 ± 1.206.51 ± 1.470.958
LVEF61.03 ± 11.9659.69 ± 13.420.379
Table 3.  Comparison of clinical outcomes between two groups
Low-Lp(a)High-Lp(a)
Variable(< 118 mmol)(≥ 118 mmol/L)P value
n = 174n = 176
Cardio-vascular death4 (2.2%)6 (3.4%)0.53
Recurrent myocardial infarction3 (1.7%)6 (3.4%)0.31
Ischemic stroke2 (1.1%)2 (1.1%)0.99
Revascularization*12 (6.9%)24 (13.3%)0.031
In-stent restenosis1 (0.6%)3 (1.7%)0.623
Figure 2.  Comparison of primary clinical endpoints between 2 groups. The x-axis represented 5 clinical endpoints, which included cardio-vascular death (A), recurrent myocardial infarction (B), ischemic stroke (C), revascularization (D) and in-stent restenosis (E). Patients in each endpoint event were assigned to high-Lp (a) group (≥118mmol/L) and low-Lp (a) group (<118mmol/L), which were shown as "red" and "blue" respectively.

Table 4.  Univariate and multivariate p value and ORs of clinical outcomes
CharacteristiesTVR group
(n = 36)
Non-TVR group
(n = 314)
Univariate
OR (95%CI)
P value Multivariate
OR (95%CI)
P value
Categorical data
Male29 (80.6%)253 (80.6%)1.331 (0.598-2.961)0.484————
Current smoker17 (47.2%)121 (38.5%)1.278 (0.648-2.519)0.479————
Diabetes mellitus1*/2*16 (44.4%)87 (27.7%)1.905 (1.168-3.331)0.0381.783 (1.053-3.021)0.044
Statin36 (100%)289 (92.0%)——0.998————
ACEI/ARB30 (83.3%)264 (84.1%)0.682 (0.295-1.577)0.368————
BETA30 (83.3%)271 (86.3%)0.567 (0.243-1.322)0.189————
Aspirin36 (100%)314 (100%)————————
Clopidogrel36 (100%)314 (100%)————————
Left main disease6 (16.7%)51 (16.2%)0.960 (0.382-2.413)0.93————
High level of Lp(a)1*/2*24 (66.7%)152 (48.4%)2.502 (1.188-4.967)0.0212.340 (1.140-4.803)0.028
Continuous data (mean ± SD)
Age (yrs)62.54 ± 9.4963.61 ± 10.980.991 (0.961-1.022)0.568————
SBP1*135.68 ± 16.61126.63 ± 18.161.076 (1.032-1.124)0.042——0.083
DBP73.32 ± 10.0675.66 ± 11.150.980 (0.949-1.012)0.217————
creatinine81.46 ± 20.8386.65 ± 22.870.989 (0.973-1.005)0.183————
albumin36.00 ± 4.6736.01 ± 4.740.999 (0.928-1.076)0.987————
CHO3.01 ± 0.413.25 ± 0.830.568 (0.305-1.060)0.075————
TG1.22 ± 0.711.61 ± 2.190.835 (0.597-1.167)0.291————
LDL-C1.46 ± 0.241.47 ± 0.250.749 (0.205-2.734)0.662————
HDL-C1*0.83 ± 0.210.95 ± 0.330.380 (0.096-0.992)0.047——0.125
HBA1C6.45 ± 1.636.52 ± 1.310.961 (0.720-1.282)0.787————
LVEF60.81 ± 12.3360.30 ± 12.821.003 (0.974-1.033)0.831————
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