Lipoprotein(a) as a Predictor of Lesion Complexity in Patients undergoing Elective Percutaneous Coronary Intervention: Insights from an Asian single center cohort

초록

BACKGROUND Lipoprotein(a) [Lp(a)] is a recognized independent risk factor for cardiovascular disease. However, its association with coronary lesion complexity, particularly among Asian populations, remains under-investigated. METHODS We conducted a retrospective study involving 573 Asian patients who underwent elective PCI (2004–2021). Participants were stratified by Lp(a) levels into two groups: < 50 mg/dL and > 50 mg/dL. A lesion complexity score (range 0–5) was assigned based on five angiographic features: chronic total occlusion (CTO), use of > 2 stents, total stent length > 60 mm, bifurcation PCI, and multivessel disease. Multivariable linear regression was used to identify independent predictors of lesion complexity. RESULTS Among 573 patients, 142 (24.8%) had Lp(a) > 50 mg/dL. Patients with elevated Lp(a) were more often female, had elevated LDL-cholesterol, and a greater prevalence of diabetes. Lesion complexity was significantly higher in patients with elevated Lp(a) (mean score 4.201.49 vs. 2.88 ± 1.75, p < 0.001). In multivariable analysis, Lp(a) > 50 mg/dL remained an independent predictor of lesion complexity (B - 1.24, 95% CI: 0.88–1.61, p < 0.001), along with diabetes and LDL-cholesterol. CONCLUSION Elevated Lp(a) (> 50 mg/dL) was independently associated with greater lesion complexity in Asian patients undergoing elective PCI. These findings support the value of Lp(a) not only as a cardiovascular risk marker, but also as a predictor of procedural challenge and complexity.