In patients who underwent PCI with LDL-C controlled below 70 mg/dl, elevated Lp(a) ≥ 50 mg/dl was not significantly associated with MACE (HR 1.07; 95% CI 0.84-1.37; P=0.91).
Cohort (n=878)
Yes
Does elevated Lp(a) ≥ 50 mg/dl increase the risk of MACE or all-cause mortality in post-PCI patients with controlled LDL-C < 70 mg/dl?
In post-PCI patients with LDL-C controlled to <70 mg/dl, elevated Lp(a) ≥ 50 mg/dl is not associated with an increased risk of MACE or all-cause mortality.
Effect estimate: HR 1.07 (95% CI 0.84-1.37)
p-value: p=0.91
BACKGROUND: Lipoprotein(a) Lp(a) is an independent, causal risk factor for cardiovascular disease. However, it is still unclear whether controlling low-density lipoprotein cholesterol (LDL-C) to optimal levels can attenuate cardiovascular risk mediated by elevated Lp(a), especially in the setting of secondary prevention. METHODS: Adult patients with a baseline Lp(a) measurement who underwent percutaneous coronary intervention (PCI) and reached their LDL-C target levels (<70 mg/dl) at Mayo Clinic sites between 2006 and 2017 were included. Primary outcomes included major adverse cardiovascular events (MACE) and all-cause mortality. Kaplan-Meier curves were created to compare the survival probabilities among patients with Lp(a) ≥ 50 mg/dl compared with Lp(a) < 50 mg/dl. Multivariable Cox regression analyses were performed to quantify the association of elevated Lp(a) with our relevant outcomes and to control for possible confounders. RESULTS: In total, 878 patients (median age: 68 years, and 74% males) who underwent PCI were included for analysis. Of them, 29.7% had elevated Lp(a) ≥ 50 mg/dl. Kaplan-Meier curves did not reveal any significant difference in survival probabilities for elevated Lp(a) for any outcome including MACE ( P = 0.91), all-cause mortality ( P = 0.26), or the separate MACE components. Similarly, the multivariable analysis showed no significant association for MACE (hazard ratio: 1.07, 95% confidence interval: 0.84-1.37) or all-cause mortality (hazard ratio: 0.98, 95% confidence interval: 0.74-1.30). CONCLUSION: In patients who underwent PCI and have their LDL-C controlled below 70 mg/dl, no significant association was found between elevated Lp(a) ≥ 50 mg/dl and risk for MACE or all-cause mortality.
Mahmoud et al. (Thu,) conducted a cohort in Percutaneous coronary intervention with controlled LDL-C (n=878). Elevated Lipoprotein(a) ≥ 50 mg/dl vs. Lipoprotein(a) < 50 mg/dl was evaluated on Major adverse cardiovascular events (MACE) (HR 1.07, 95% CI 0.84-1.37, p=0.91). In patients who underwent PCI with LDL-C controlled below 70 mg/dl, elevated Lp(a) ≥ 50 mg/dl was not significantly associated with MACE (HR 1.07; 95% CI 0.84-1.37; P=0.91).
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