Our study aimed to evaluate the association of lipoprotein(a) [Lp(a)] and prognosis
in patients with nonobstructive coronary artery disease (CAD). A total of 4,254 symptomatic
patients with suspected CAD referred for coronary angiography were analyzed and 451
patients (250 women, average age 58 ± 9 years) with nonobstructive CAD (defined as
no angiographic stenosis ≥50% in any major epicardial artery) were finally included
in our cohort. Subjects were categorized into tertile groups according to Lp(a) levels
on admission. The primary end point was major adverse cardiovascular events (MACEs),
defined as cardiac death and incident acute coronary syndrome. Over a mean follow-up
of 32 ± 22 months, 37 (8%) MACE (15 cases of cardiac death and 22 cases of acute coronary
syndrome) occurred. Kaplan–Meier analysis revealed that elevated Lp(a) level was associated
with worse prognosis (p = 0.001). After Cox multivariate adjustment for other clinical
confounders, an elevated Lp(a) level remained an independent predictor of MACE either
as a continuous variable (hazard ratio 1.031, 95% confidence interval 1.019 to 1.043,
p <0.001) or as a categorical variable (hazard ratio 3.155, 95% confidence interval
1.599 to 6.229, p = 0.001). Furthermore, addition of Lp(a) to established coronary
risk factors significantly improved the predictive value of reference models for MACE.
In conclusion, an elevated Lp(a) level is independently associated with worse prognosis
and may provide useful risk stratification in symptomatic patients with nonobstructive
CAD.
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Article info
Publication history
Published online: January 05, 2017
Accepted:
November 29,
2016
Received in revised form:
November 29,
2016
Received:
October 22,
2016
Footnotes
See page 949 for disclosure information.
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