Predictive value of Lp(a) for MACE in ACS patients with T2DM following PCI, with achieved LDL-C target: A cross-sectional study

Objective It is widely accepted that elevated low-density lipoprotein cholesterol (LDL-C) levels are a major risk factor for coronary heart disease (CHD). However, even patients who have achieved LDL-C levels below the currently recommended targets may still have residual risk. Recently, Lipoprotein(a) [Lp(a)] has attracted significant attention as independent causal risk factor for CHD. Nonetheless, the role of Lp(a) in acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) who have undergone percutaneous coronary intervention (PCI) and achieved the LDL-C target (≤1.4 mmol/L) remains unclear. Methods This retrospective study enrolled 462 ACS patients with comorbid T2DM who underwent PCI, with a median follow-up duration of 27 months post-procedure. The primary endpoint was major adverse cardiovascular events (MACE), defined as all-cause death, recurrent acute myocardial infarction (AMI), ischemic stroke, or hospitalization due to recurrent angina. Based on MACE occurrences, patients were divided into MACE group and non-MACE group. Furthermore, patients were further divided into three groups according to their Lp(a) levels. Kaplan–Meier and Cox regression analyses were performed. Results Patients with MACE had more coronary artery lesions, and the plasma Lp(a) concentrations in the MACE group were significantly higher than in the non-MACE group. The incidence of MACE and recurrent AMI was higher in the Lp(a) ≥ 180 mg/dL group compared to the other two groups. Even after multivariate adjustment, Lp(a) ≥ 180 mg/dL remained closely associated with an increased risk of MACE (HR 2.82, 95% CI: 1.47–5.41, P = .002) and recurrent AMI (HR 3.71, 95% CI: 1.17–11.81, P = .026). Conclusion Elevated Lp(a) levels were strongly associated with poor prognosis in ACS patients with T2DM who underwent PCI.