Beyond Risk Prediction: Lp(a) As A Marker of Procedural Complexity in Asian Patients Undergoing PCI

초록

BACKGROUND Lipoprotein(a) [Lp(a)] is a recognized cardiovascular risk factor, but its link to coronary lesion complexity in Asian percutaneous coronary intervention (PCI) patients remains underexplored. OBJECTIVES To assess whether elevated Lp(a) is associated with higher coronary lesion complexity in a large Asian PCI cohort. METHODS We analyzed 1,829 Asian patients undergoing PCI with measured Lp(a). An ethnicity-appropriate threshold of ≥30 mg/dL was used, with ≥50 mg/dL as secondary. Lesion complexity was defined using a 6-component score (0-6) including chronic total occlusion, bifurcation, multivessel disease, severe calcification, ≥2 stents, and stent length ≥60 mm. The score correlated with Gensini (r=0.58). Propensity-score matching (1:1) and multivariable regression accounted for confounding. RESULTS Of 1,829 patients (mean age 63.3 years; 67% male), 35% had Lp(a) ≥30 mg/dL. After matching (498 pairs; all SMD <0.10), elevated Lp(a) remained associated with higher complexity (2.28 vs 1.45; P<0.001). All individual components―including chronic total occlusion (18.9% vs 8.4%), multivessel disease (46.0% vs 28.7%), and severe calcification (30.9% vs 15.9%)―were significantly more frequent (all P<0.001). In adjusted models, Lp(a) ≥30 mg/dL independently predicted higher complexity (β=0.834; P<0.001). Effect modification was significant for diabetes (stronger effect; P=0.004) and sex (greater in females; P=0.029). A dose-response pattern was observed across <30, 30-49, and ≥50 mg/dL (P-trend<0.001). High Lp(a) markedly increased the probability of maximal complexity (8.6% vs 0.5%). CONCLUSION Elevated Lp(a) independently predicts substantially greater coronary lesion complexity in Asian PCI patients, with stronger effects in diabetics and women, supporting routine Lp(a) assessment for procedural planning.