Prognostic Impact of Lipoprotein(a) on Cardiovascular Outcomes Across Coronary Complexity in Patients Undergoing Coronary Revascularization.

BACKGROUND: Elevated lipoprotein(a) [Lp(a)] and high coronary anatomical complexity are individually associated with increased cardiovascular risk. However, their combined prognostic impact in patients undergoing coronary revascularization remains unclear. OBJECTIVES: The authors aimed to assess the prognostic impact of elevated Lp(a) according to coronary anatomical complexity in patients undergoing percutaneous coronary intervention or coronary artery bypass surgery. METHODS: We analyzed 4,591 patients who underwent percutaneous coronary intervention or coronary artery bypass surgery at Asan Medical Center between January 2003 and December 2011 and had available Lp(a) and SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score data. Elevated Lp(a) was defined as ≥50 mg/dL, and coronary complexity was categorized according to SYNTAX scores (<23, 23-33, and ≥33). The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke. Median follow-up duration was 4.9 years. RESULTS: Among 4,591 patients (mean age, 63 years), 976 (21%) had elevated Lp(a) levels. Patients with elevated Lp(a) had a higher incidence of the primary endpoint than those with Lp(a) < 50 mg/dL (14% vs 11%; adjusted HR: 1.26; 95% CI: 1.04-1.53; P = 0.019). In analyses stratified by coronary complexity, elevated Lp(a) was significantly associated with the primary endpoint in patients with SYNTAX ≥33 (27% vs 18%; adjusted HR: 1.62; 95% CI: 1.13-2.32; P = 0.008), but not in those with SYNTAX <23 or SYNTAX 23-33 (P for interaction = 0.180). Elevated Lp(a) remained an independent predictor after adjustment for clinical and angiographic characteristics. CONCLUSIONS: Elevated Lp(a) was independently associated with worse clinical outcomes. This effect appeared more pronounced in patients with high coronary anatomical complexity.