Please wait a minute...
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
Download:  PDF(321KB)  ( 868 ) Full text   ( 28 )
Export:  BibTeX | EndNote (RIS)      

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     
2017QTLXXM28/"innovative and strong university" project of Guangdong Pharmaceutical University
*Corresponding Author(s):  Jianyi Zheng     E-mail:

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:     OR

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
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
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)
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————
[1] Boullier, A.,Walters-Laporte, E.,Hamon, M.,Tailleux, A.,Amant, C.,Amouyel, P.,Fruchart, J.,Bertrand, M.,Duriez, P. (2000)Absence of relationship between plasma Lp(a), Lp-AI, anti-oxidized LDL autoantibodies, LDL immune complexes concentrations and restenosis after percutaneous transluminal coronary angioplasty.Clinica Chimica Acta 299, 129-140
[2] Cao, J.,Steffen, B.T.,Guan, W.,Budoff, M.,Michos, E.D.,Kizer, J.R.,Post, W.S.,Tsai, M.Y. (2017)Evaluation of lipoprotein(a) electrophoretic and immunoassay methods in discriminating risk of calcific aortic valve disease and incident coronary heart disease: the multi-ethnic study of atherosclerosis.Clinical Chemistry 63, 1705-1713.
[3] Grundy, S.M.,Stone, N.J.,Bailey, A.L.,Beam, C.,Birtcher, K.K.,Blumenthal, R.S.,Braun, L.T.,de Ferranti, S.,Faiella-Tommasino, J.,Forman, D.E.,Goldberg, R.,Heidenreich, P.A.,Hlatky, M.A.,Jones, D.W.,Lloyd-Jones, D.,Lopez-Pajares, N.,Ndumele, C.E.,Orringer, C.E.,Peralta, C.A.,Saseen, J.J.,Smith, S.J.,Sperling, L.,Virani, S.S.,Yeboah, J. (2019)2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation 139, e1046-e1081.
[4] Gragnano, F.,Fimiani, F.,Di Maio, M.,Cesaro, A.,Limongelli, G.,Cattano, D.,Calabro, P. (2019)Impact of lipoprotein(a) levels on recurrent cardiovascular events in patients with premature coronary artery disease.Internal and Emergency Medicine 14, 621-625
[5] Gragnano, F.,Natale, F.,Concilio, C.,Fimiani, F.,Cesaro, A.,Sperlongano, S.,Crisci, M.,Limongelli, G.,Calabro, R.,Russo, M.,Golia, E.,Calabro, P. (2018)Adherence to proprotein convertase subtilisin/kexin 9 inhibitors in high cardiovascular risk patients: an Italian single-center experience.Journal of Cardiovascular Medicine 19, 75-77.
[6] Hartmann, M.,von Birgelen, C.,Mintz, G.S.,Stoel, M.G.,Eggebrecht, H.,Wieneke, H.,Fahy, M.,Neumann, T.,van der Palen, J.,Louwerenburg, H.W.,Verhorst, P.M.,Erbel, R. (2006)Relation between lipoprotein(a) and fibrinogen and serial intravascular ultrasound plaque progression in left main coronary arteries.Journal of the American College of Cardiology 48, 446-452.
[7] Hohenstein, B.,Julius, U.,Lansberg, P.,Jaeger, B.,Mellwig, K.P.,Weiss, N.,Graehlert, X.,Roeder, I.,Ramlow, W. (2017)Rationale and design of multiselect: a european multicenter study on the effect of lipoprotein(a) elimination by lipoprotein apheresis on cardiovascular outcomes.Atherosclerosis Supplements 30, 180-186.
[8] Huang, Y. (2019)Establishing age and sex-dependent upper reference limits for the plasma lipoprotein (a) in a Chinese health check-up population and according to its relative risk of primary myocardial infarction.Clinica Chimica Acta 496, 140.
[9] Khera, A.V.,Everett, B.M.,Caulfield, M.P.,Hantash, F.M.,Wohlgemuth, J.,Ridker, P.M.,Mora, S. (2014)Lipoprotein(a) concentrations, rosuvastatin therapy, and residual vascular risk: an analysis from the JUPITER Trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin).Circulation 129, 635-642.
[10] Konishi, H.,Miyauchi, K.,Shitara, J.,Endo, H.,Wada, H.,Doi, S.,Naito, R.,Tsuboi, S.,Ogita, M.,Dohi, T.,Kasai, T.,Okazaki, S.,Isoda, K.,Suwa, S.,Daida, H. (2016)Impact of lipoprotein(a) on long-term outcomes in patients with diabetes mellitus who underwent percutaneous coronary intervention.American Journal of Cardiology 118, 1781-1785.
[11] Konishi, H.,Miyauchi, K.,Tsuboi, S.,Ogita, M.,Naito, R.,Dohi, T.,Kasai, T.,Tamura, H.,Okazaki, S.,Isoda, K.,Daida, H. (2016)Plasma lipoprotein(a) predicts major cardiovascular events in patients with chronic kidney disease who undergo percutaneous coronary intervention.International Journal of Cardiology 205, 50-53.
[12] Ling, Y.,Jiang, J.,Wu, B.,Gao, X. (2017)Serum triglyceride, high-density lipoprotein cholesterol, apolipoprotein B, and coronary heart disease in a Chinese population undergoing coronary angiography.Journal of Clinical Lipidology 11, 646-656.
[13] Lloyd-Jones, D.M.,Wilson, P.W.,Larson, M.G.,Beiser, A.,Leip, E.P.,D'Agostino, R.B.,Levy, D. (2004)Framingham risk score and prediction of lifetime risk for coronary heart disease.American Journal of Cardiology 94, 20-24.
[14] Maharjan, P.,Manandhar, R.,Xu, W.,Ma, S.,Han, W.,Liu, Y.,Zhou, Y.,Rijal, Y.,Sun, C.,Yuan, Z. (2015)markers of autolysis in acute ST-elevation myocardial infarction.Journal of Nepal Medical Association 53, 96-103.
[15] Mach, F.,Baigent, C.,Catapano, A.L.,Koskinas, K.C.,Casula, M.,Badimon, L.,Chapman, M.J.,De Backer, G.G.,Delgado, V.,Ference, B.A.,Graham, I.M.,Halliday, A.,Landmesser, U.,Mihaylova, B.,Pedersen, T.R.,Riccardi, G.,Richter, D.J.,Sabatine, M.S.,Taskinen, M.R.,Tokgozoglu, L.,Wiklund, O. (2020)2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.European Heart Journal 41, 111-188.
[16] Park, S.H.,Rha, S.W.,Choi, B.G.,Park, J.Y.,Jeon, U.,Seo, H.S.,Kim, E.J.,Na, J.O.,Choi, C.U.,Kim, J.W.,Lim, H.E.,Park, C.G.,Oh, D.J. (2015)Impact of high lipoprotein(a) levels on in-stent restenosis and long-term clinical outcomes of angina pectoris patients undergoing percutaneous coronary intervention with drug-eluting stents in Asian population.Clinical and Experimental Pharmacology and Physiology 42, 588-595.
[17] Shai, I.,Schulze, M.B.,Manson, J.E.,Stampfer, M.J.,Rifai, N.,Hu, F.B. (2005)A prospective study of lipoprotein(a) and risk of coronary heart disease among women with type 2 diabetes.Diabetologia 48, 1469-1476.
[18] Shapiro, M.D.,Minnier, J.,Tavori, H.,Kassahun, H.,Flower, A.,Somaratne, R.,Fazio, S. (2019)Relationship between low-density lipoprotein cholesterol and lipoprotein(a) lowering in response to PCSK9 inhibition with evolocumab.Journal of the American Heart Association 8, e10932.
[19] Schwartz, G.G.,Ballantyne, C.M.,Barter, P.J.,Kallend, D.,Leiter, L.A.,Leitersdorf, E.,McMurray, J.,Nicholls, S.J.,Olsson, A.G.,Shah, P.K.,Tardif, J.C.,Kittelson, J. (2018)Association of Lipoprotein(a) With risk of recurrent ischemic events following acute coronary syndrome: analysis of the dal-outcomes randomized clinical trial.JAMA Cardiology 3, 164-168.
[20] Tato, F.,Keller, C.,Schuster, H.,Spengel, F.,Wolfram, G.,Zollner, N. (1993)Relation of lipoprotein(a) to coronary heart disease and duplex sonographic findings of the carotid arteries in heterozygous familial hypercholesterolemia.Atherosclerosis 101, 69-77.
[21] Tsimikas, S. (2017)A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies.Journal of the American College of Cardiology 69, 692-711.
[22] Yang, Q.,He, Y.M.,Cai, D.P.,Yang, X.J.,Xu, H.F. (2016)Risk burdens of modifiable risk factors incorporating lipoprotein (a) and low serum albumin concentrations for first incident acute myocardial infarction.Scientific Reports 6, 35463.
[1] Meer Fakhry, Mandeep S. Sidhu, Sripal Bangalore, Roy O. Mathew. Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease[J]. Reviews in Cardiovascular Medicine, 2020, 21(2): 157-162.
[2] Anthony (Ming-yu) Chuang, Mau T Nguyen, Woon-Man Kung, Sam Lehman, Derek P Chew. High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond[J]. Reviews in Cardiovascular Medicine, 2020, 21(2): 191-203.
[3] Zhanru Qi, Hongyan Zheng, Zhonghai Wei, Qing Dai, Jun Xie, Lian Wang, Jingmei Zhang, Jie Song. Short-term and long-term outcomes of bailout versus planned coronary rotational atherectomy[J]. Reviews in Cardiovascular Medicine, 2020, 21(2): 309-314.
[4] Federico Ronco, Giuseppe Tarantini, Peter A. McCullough. Contrast induced acute kidney injury in interventional cardiology: an update and key guidance for clinicians[J]. Reviews in Cardiovascular Medicine, 2020, 21(1): 9-23.
[5] En Chen, Wei Cai, Danqing Hu, Lianglong Chen. Effect of remote ischemic preconditioning in patients with STEMI during primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials[J]. Reviews in Cardiovascular Medicine, 2020, 21(1): 103-112.
[6] Ya Wang, Wen-Jing Sun, Ze-Sheng Ji, Chong-Bin Liu, Rui Wang. Serum albumin and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention[J]. Reviews in Cardiovascular Medicine, 2020, 21(1): 139-145.
[7] Christian O. Koelbl, Zoran S. Nedeljkovic, Alice K. Jacobs. Coronary Chronic Total Occlusion (CTO): A Review[J]. Reviews in Cardiovascular Medicine, 2018, 19(1): 33-39.
[8] Akanksha Agrawal, Deepanshu Jain, Eyob L. Feyssa, Aman M. Amanullah. Utility of Dobutamine Stress Echocardiography in Cardiac Risk Stratification of Patients Undergoing Orthotopic Liver Transplantation[J]. Reviews in Cardiovascular Medicine, 2017, 18(4): 146-154.
[9] William Finch, Michael S. Lee. Percutaneous Coronary Intervention for Coronary Bifurcation Lesions[J]. Reviews in Cardiovascular Medicine, 2017, 18(2): 59-66.
[10] Craig Basman, Michael C. Kim, Neil L. Coplan. Timing of Percutaneous Coronary Intervention and Therapeutic Hypothermia in Patients With ST-Elevation Myocardial Infarction and Out-of-hospital Cardiac Arrest[J]. Reviews in Cardiovascular Medicine, 2017, 18(2): 67-72.
[11] Mehul A. Pragani, Karan P. Desai, Doralisa Morrone, Mandeep S. Sidhu, William E. Boden. The Role of Nitrates in the Management of Stable Ischemic Heart Disease: A Review of the Current Evidence and Guidelines[J]. Reviews in Cardiovascular Medicine, 2017, 18(1): 14-20.
[12] Sandeep K. Krishnan, Alex Zhu, Brent Larson>, Timothy D. Henry, Suhail Dohad. Spontaneous Coronary Artery Dissection: Insights From Histology and Optical Coherence Tomography[J]. Reviews in Cardiovascular Medicine, 2017, 18(1): 44-52.
[13] Nachiket Patel, Elizabeth Ngo, Timothy E. Paterick, Khawaja Afzal Ammar, Krishnaswamy Chandrasekaran, A. Jamil Tajik. ST-segment Elevation: Myocardial Infarction or Simulacrum?[J]. Reviews in Cardiovascular Medicine, 2016, 17(3-4): 85-99.
[14] Daniel Levin, Shweta Bansal, Anand Prasad. The Role of Novel Cardiorenal Biomarkers in the Cardiac Catheterization Laboratory for the Detection of Acute Kidney Injury[J]. Reviews in Cardiovascular Medicine, 2016, 17(3-4): 100-114.
[15] Ashish H. Shah, Nick Ossei-Gerning, Rito Mitra. Rotational Atherectomy in a Dissected Coronary Artery That Propagated Into the Sinus of Valsalva: Is This the Last Hope?[J]. Reviews in Cardiovascular Medicine, 2016, 17(3-4): 137-139.
No Suggested Reading articles found!