Impact of High Lipoprotein(a) on Long‐Term Survival Following Coronary Artery Bypass Grafting

Abstract

Background Lipoprotein(a) is a possible causal risk factor for atherosclerosis and related complications. The distribution and prognostic implication of lipoprotein(a) in patients undergoing coronary artery bypass grafting remain unknown. This study aimed to assess the impact of high lipoprotein(a) on the long‐term prognosis of patients undergoing coronary artery bypass grafting. Methods and Results Consecutive patients with stable coronary artery disease who underwent isolated coronary artery bypass grafting from January 2013 to December 2018 from a single‐center cohort were included. The primary outcome was all‐cause death. The secondary outcome was a composite of major adverse cardiovascular and cerebrovascular events. Of the 18 544 patients, 4072 (22.0%) were identified as the high‐lipoprotein(a) group (≥50 mg/dL). During a median follow‐up of 3.2 years, primary outcomes occurred in 587 patients. High lipoprotein(a) was associated with increased risk of all‐cause death (high lipoprotein(a) versus low lipoprotein(a): adjusted hazard ratio [aHR], 1.31 [95% CI, 1.09–1.59]; P =0.005; lipoprotein(a) per 1‐mg/dL increase: aHR, 1.003 [95% CI, 1.001–1.006]; P =0.011) and major adverse cardiovascular and cerebrovascular events (high lipoprotein(a) versus low lipoprotein(a): aHR, 1.18 [95% CI, 1.06–1.33]; P =0.004; lipoprotein(a) per 1‐mg/dL increase: aHR, 1.002 [95% CI, 1.001–1.004]; P =0.002). The lipoprotein(a)‐related risk was greater in patients with European System for Cardiac Operative Risk Evaluation <3, and tended to attenuate in patients receiving arterial grafts. Conclusions More than 1 in 5 patients with stable coronary artery disease who underwent coronary artery bypass grafting were exposed to high lipoprotein(a), which is associated with higher risks of death and major adverse cardiovascular and cerebrovascular events. The adverse effects of lipoprotein(a) were more pronounced in patients with clinically low‐risk profiles or not receiving arterial grafts.