The prognostic significance of Lipoprotein(a) is modified by obstructive sleep apnea in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Background Lipoprotein(a) [Lp(a)] is an established residual cardiovascular risk factor in patients with atherosclerotic cardiovascular disease. Obstructive sleep apnea (OSA), a common cardiometabolic disorder, may modify the association between Lp(a) and cardiovascular outcomes. Therefore, the present study aimed to further evaluate whether OSA statistically modifies the association between Lp(a) and long-term cardiovascular outcomes in a prospective cohort of patients with acute coronary syndrome (ACS). Methods A total of 1027 consecutive patients who underwent PCI and sleep study were initially screened. After prespecified exclusions, 846 patients were included in the final analysis. Moderate-to-severe OSA was defined as an AHI ≥15 events/h, whereas patients with an AHI <15 events/h constituted the comparison group. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiovascular death, myocardial infarction, heart failure and stroke. Results During 3.5(2.8-4.2) years of follow-up, 169(19.97%) cardiovascular events occurred. Post-PCI patients who experienced MACEs exhibited significantly higher Lp(a) levels compared to those without MACEs (median 26.50 vs.11.00 mg/dL, P<0.001). Post-PCI patients with high Lp(a)(>30mg/dL) were associated with increased risks of cardiovascular events with hazard ratios of 1.881 (95%CI 1.168-3.029, P<0.001). There was a statistically significant interaction between Lp(a) and OSA status in relation to MACE risk (P for interaction=0.005). Among patients with AHI ≥15 events/h, elevated Lp(a) (>30 mg/dL) was associated with a 2.286-fold higher risk of MACEs compared to Lp(a) (<10 mg/dL), whereas no statistically significant association was observed among patients with AHI <15 events/h. Conclusion OSA status may statistically modify the association between elevated Lp(a) and cardiovascular outcomes in patients with ACS undergoing PCI. These findings support further investigation into the prognostic relevance of combined OSA and Lp(a) assessment, while additional studies are needed to validate these observations and determine their implications for clinical practice.