Impact of High Lipoprotein(a) Levels on 5-Year Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-Eluting Stent in Korean Population

초록

Background This study evaluated the association between elevated levels of lipoprotein(a) [Lp(a)] and the long-term risk of recurrent ischemic events in patients who underwent percutaneous coronary intervention (PCI), and tracked changes in Lp(a) over time. Methods The study population was enrolled from the Korea University Guro hospital (KUGH)-PCI registry from January 2004 to January 2018. A total of 5,790 patients (pts) who underwent PCI with drug-eluting stents (DESs), and have been completed clinical follow-up for 5 years. All subjects were divided into 2 groups according to Lp(a) level; Lp(a) ≥50 mg/dL (n = 319 pts), Lp(a) <50 mg/d (n = 1,701 pts). Results The Lp(a) ≥50 group was 15.8% (319/2,020) of the total. Although there were more men (59.5% vs 68.7%; P = 0.001) in the Lp(a) <50 group, baseline, angiographic and procedural characteristics were well balanced between the 2 groups. In a 5-year clinical follow-up, compared with the Lp(a) <50 group, the Lp(a) ≥50 group had significantly more cardiovascular events, including myocardial infarction (7.5% vs 3.5%; P = 0.001), repeated-PCI (20.3% vs 13.6%; P = 0.002), and stent thrombosis (4.0% vs 1.8%; P = 0.015). The use of statins or ezetimibe did not significantly reduce Lp(a) levels between the time of PCI and up to 1 year in the Lp(a) ≥50 group. Conclusions This observational study demonstrated that elevated baseline Lp(a) levels in patients who underwent PCI were significantly associated with recurrent ischemic events. The prescription of statins or ezetimibe at discharge did not significantly reduce Lp(a) levels up to one-year follow-up.