Impact of Lipoprotein (a) Levels on Long-Term Outcomes in Patients With Coronary Artery Disease and Left Ventricular Systolic Dysfunction

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  • Shitara Jun
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Kasai Takatoshi
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital
  • Konishi Hirokazu
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Endo Hirohisa
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Wada Hideki
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Doi Shinichiro
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Naito Ryo
    Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
  • Tsuboi Shuta
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Ogita Manabu
    Department of Cardiology, Juntendo University Shizuoka Hospital
  • Dohi Tomotaka
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Okazaki Shinya
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Miyauchi Katsumi
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Daida Hiroyuki
    Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine

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<p>Background: Serum levels of lipoprotein (a) (Lp(a)) could be a risk factor for adverse events in patients with coronary artery disease (CAD). However, the effect of Lp(a) on long-term outcomes in patients with left ventricular (LV) systolic dysfunction, possibly through the increased likelihood for development of heart failure (HF), remains to be elucidated. This study aimed to determine the prognostic impact of Lp(a) in patients with CAD and LV systolic dysfunction. </p><p>Methods and Results: A total of 3,508 patients who underwent percutaneous coronary intervention were candidates. We analyzed 369 patients with LV systolic dysfunction (defined as LV ejection fraction <50%). They were assigned to groups according to a median level of Lp(a) (i.e., high Lp(a), ≥21.6 mg/dL, n=185; low Lp(a), <21.6 mg/dL, n=184). The primary outcome was a composite of all-cause death and readmission for acute coronary syndrome and/or HF. The median follow-up period was 5.1 years. Cumulative event-free survival was significantly worse for the group with high Lp(a) than for the group with low Lp(a) (P=0.005). In the multivariable analysis, a high Lp(a) level was an independent predictor of the primary outcomes (hazard ratio, 1.54; 95% confidence interval, 1.09–2.18; P=0.014). </p><p>Conclusions: A high Lp(a) value could be associated with long-term adverse clinical outcomes among patients with CAD and LV systolic dysfunction. </p>

収録刊行物

  • Circulation Journal

    Circulation Journal 83 (5), 1047-1053, 2019-04-25

    一般社団法人 日本循環器学会

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