Lipoprotein(a) and Long-Term Cardiovascular Events in Patients With Coronary Vasospasm

초록

BACKGROUND Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein associated with atherosclerotic cardiovascular disease, but its prognostic relevance in coronary vasospasm remains unclear. We evaluated the relationship between Lp(a) levels and cardiovascular outcomes in patients undergoing spasm provocation testing. METHODS We retrospectively analyzed 2,977 patients who underwent coronary angiography with spasm provocation testing between 2004 and 2021. Patients were stratified by Lp(a) level (<30 mg/dL vs. >30 mg/dL), and a continuous analysis per 10 mg/dL increment was also performed. The primary endpoint was major adverse cardiovascular events (MACE). A secondary outcome was recurrent angina. Associations were assessed using Kaplan-Meier survival analysis, Cox proportional hazards, and logistic regression, adjusting for age, sex, hypertension, diabetes, smoking, statin use, and angiographic spasm (>70%). RESULTS Among 2,977 patients (mean age 56.9 ± 12.5 years, 52.8% female), 20.6% had Lp(a) >30 mg/dL. Coronary spasm was present in 58.7% with low Lp(a) and 57.6% with high Lp(a) (p=0.637). Over a median follow-up of 6,365 days (~17.4 years), MACE occurred in 96 (4.1%) and 27 (4.4%) patients with low and high Lp(a), respectively. Kaplan-Meier analysis showed no difference in MACE-free survival (log-rank p=0.619). In Cox regression, Lp(a) >30 mg/dL was not associated with MACE (adjusted HR 1.11, 95% CI 0.73–1.71, p=0.622); neither was Lp(a) per 10 mg/dL (HR 1.01, 95% CI 0.93–1.09, p=0.910). In logistic regression for recurrent angina, Lp(a) >30 mg/dL was not significant (OR 1.18, 95% CI 0.94–1.49, p=0.160); nor was Lp(a) per 10 mg/dL (OR 1.02, 95% CI 0.96–1.08, p=0.328). CONCLUSION In this large, long-term spasm registry, Lp(a) was not independently associated with MACE or recurrent angina, whether analyzed as a dichotomous or continuous variable. These findings suggest Lp(a) may have limited prognostic utility in vasospastic angina populations.