| Objective:Percutaneous coronary intervention(PCI)is an important means of reperfusion therapy for acute coronary syndrome(ACS).Low-density lipoprotein cholesterol is the main monitoring indicator of lipid-lowering therapy after PCI.However,it has been observed clinically that adverse cardiovascular events still occurred in some patients whose LDL-C control reached the standard and related risk factors were well controlled after PCI.Lipoprotein(a)[Lp(a)] is a residual risk factor for cardiovascular disease,and there is a lack of comparative studies on Lp(a)and LDL-C in predicting adverse cardiovascular events after PCI in ACS patients.Therefore,this study aims to explore the predictive value of Lp(a)and Lp(a)for cardiovascular events after PCI,and to provide theoretical basis for identifying high-risk patients and improving clinical prognosis by measuring Lp(a)level.Methods:This study was a retrospective analysis of patients who were first diagnosed with ACS and underwent PCI and who had not yet started lipid-lowering therapy.General data,laboratory indicators,and the incidence of cardiovascular events during 6 months of follow-up were compared.The end point event was defined as a composite cardiovascular event consisting of all-cause death,revascularization due to cardiac ischemia,readmission due to unstable angina,and nonfatal stroke.Chi-square test,t-test,Logistic regression analysis and receiver operating characteristic(ROC)were performed by SPSS25.0software.Odds ratio(OR)and 95% confidence interval(CI)were calculated.To further clarify the predictive value of Lp(a)in patients with low LDL-C level,a subgroup of 70 patients with LDL-C<1.8 mmol/L was established to explore the correlation between Lp(a)and cardiovascular events.Results:A total of 395 patients with ACS after PCI(mean age,62.44 years,274 men and 121women)were included in the analysis.A total of 41 cardiovascular events were observed during follow-up and included in the end-point event group.Patients with end-point events had higher preoperative Lp(a)levels than patients without end-point events(P<0.01),while there were no significant differences in LDL-C level,previous medical history and post-PCI treatment(P>0.05).Logistic regression analysis was performed on risk factors that might be associated with the end point event,and univariate logistic regression analysis suggested that Lp(a)was an independent risk factor for short-term adverse prognosis of ACS patients after PCI [OR(95%CI): 1.002(1.000-1.003),P < 0.01].Patients with Lp(a)≥30 mg/d L had a significantly higher risk of outcome events than those with LP(a)<30 mg/d L [OR(95%CI): 3.621(1.792-3.718),P<0.01].ROC curve analysis shows that,when Lp(a)and LDL-C were 24.9 mg/d L and 2.64 mmol/L,respectively,the AUC of Lp(a)and LDL-C for predicting end-point events 6 months after PCI in ACS patients were 0.702(P<0.01)and 0.524(P=0.621),respectively.The diagnostic sensitivity was 75.6% and 43.9%,and the specificity was 62.7% and 68.2%,respectively.Subgroup analysis showed that in patients with LDL-C<1.8 mmol/L,Lp(a)≥30 mg/d L group was more likely to have adverse cardiovascular events than Lp(a)<30 mg/d L group(P<0.01),increased Lp(a)level can independently increase the incidence of cardiovascular events in patients with ACS after PCI.ROC analysis showed that Lp(a)predicted end-point events after PCI in ACS patients with low LDL-C with an AUC of 0.832(95%CI: 0.711-0.954,P<0.01).Conclusion:For ACS patients after PCI,preoperative serum Lp(a)level is an independent risk factor for short-term adverse prognosis in ACS patients after PCI,and the predictive value of Lp(a)on short-term adverse prognosis is better than LDL-C. |
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