Vol 31, No 1 (2024)
Original Article
Published online: 2023-10-16

open access

Page views 1061
Article views/downloads 403
Get Citation

Connect on Social Media

Connect on Social Media

Prolonged dual antiplatelet therapy in invasively treated acute coronary syndrome patients with different lipoprotein(a) concentrations

Kongyong Cui123, Shaoyu Wu123, Dong Yin123, Weihua Song123, Hongjian Wang123, Chenggang Zhu123, Lei Feng123, Yuejin Yang123, Rui Fu123, Kefei Dou123
Pubmed: 37853822
Cardiol J 2024;31(1):32-44.


Background: Lipoprotein(a) [Lp(a)] was positively associated with recurrent ischemic events in patients with acute coronary syndrome (ACS). This study was performed to investigate the effect of Lp(a) levels on outcomes of dual antiplatelet therapy (DAPT) > 1 year versus DAPT ≤ 1 year after percutaneous coronary intervention (PCI) in this population.

Methods: A total of 4,357 ACS patients who were event-free at 1 year after PCI were selected from the Fuwai PCI Registry, and patients were stratified into four groups according to DAPT duration (≤ 1 year vs. > 1 year) and Lp(a) levels (≤ 30 mg/dL vs. > 30 mg/dL). The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of cardiac death, myocardial infarction or stroke.

Results: After 2.4-year follow-up, the incidence of MACCE (HRadjusted 0.284, 95% CI 0.115–0.700; HRIPTW 0.351, 95% CI 0.164–0.751) were significantly reduced in DAPT > 1 year group than that in DAPT ≤ 1 year group in individuals with elevated Lp(a) levels. However, in individuals with normal Lp(a) levels, no statistically difference was found between these two groups in terms of MACCE, although the risks of all-cause death and definite/probable stent thrombosis were lower in DAPT > 1 year group. Notably, the risk of clinically relevant bleeding did not statistically differ between these two groups in individuals with different Lp(a) levels.

Conclusions: This study firstly demonstrated that extended DAPT (> 1 year) was statistically associated with lower risk of ischemic events in ACS patients with elevated Lp(a) levels after PCI, whereas this association was not found in individuals with normal Lp(a) levels.

Article available in PDF format

View PDF Download PDF file


  1. Nordestgaard BG, Langsted A. Lipoprotein (a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology. J Lipid Res. 2016; 57(11): 1953–1975.
  2. Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017; 69(6): 692–711.
  3. Kamstrup PR, Benn M, Tybjaerg-Hansen A, et al. Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population: the Copenhagen City Heart Study. Circulation. 2008; 117(2): 176–184.
  4. Erqou S, Kaptoge S, Perry PL, et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009; 302(4): 412–423.
  5. Kamstrup PR, Tybjærg-Hansen A, Nordestgaard BG, et al. Genetically elevated lipoprotein(a) and increased risk of myocardial infarction. JAMA. 2009; 301(22): 2331–2339.
  6. Clarke R, Peden JF, Hopewell JC, et al. Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N Engl J Med. 2009; 361(26): 2518–2528.
  7. Cui K, Yin D, Zhu C, et al. Impact of lipoprotein(a) concentrations on long-term cardiovascular outcomes in patients undergoing percutaneous coronary intervention: A large cohort study. Nutr Metab Cardiovasc Dis. 2022; 32(7): 1670–1680.
  8. Konishi H, Miyauchi K, Shitara J, et al. Impact of lipoprotein(a) on long-term outcomes in patients with diabetes mellitus who underwent percutaneous coronary intervention. Am J Cardiol. 2016; 118(12): 1781–1785.
  9. Ren Y, Pan W, Li X, et al. The predictive value of Lp(a) for adverse cardiovascular event in ACS patients with an achieved LDL-C target at follow up after PCI. J Cardiovasc Transl Res. 2022; 15(1): 67–74.
  10. Xue Y, Jian S, Zhou W, et al. Associations of lipoprotein(a) with coronary atherosclerotic burden and all-cause mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Front Cardiovasc Med. 2021; 8: 638679.
  11. Lacaze P, Bakshi A, Riaz M, et al. Aspirin for primary prevention of cardiovascular events in relation to lipoprotein(a) genotypes. J Am Coll Cardiol. 2022; 80(14): 1287–1298.
  12. Chasman DI, Shiffman D, Zee RYL, et al. Polymorphism in the apolipoprotein(a) gene, plasma lipoprotein(a), cardiovascular disease, and low-dose aspirin therapy. Atherosclerosis. 2009; 203(2): 371–376.
  13. Capodanno D, Alfonso F, Levine GN, et al. ACC/AHA Versus ESC Guidelines on Dual Antiplatelet Therapy: JACC Guideline Comparison. J Am Coll Cardiol. 2018; 72(23 Pt A): 2915–2931.
  14. Zhang D, Yan R, Gao G, et al. Validating the performance of 5 risk scores for major adverse cardiac events in patients who achieved complete revascularization after percutaneous coronary intervention. Can J Cardiol. 2019; 35(8): 1058–1068.
  15. Cui K, Wang HY, Yin D, et al. Benefit and risk of prolonged dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stents in patients with elevated lipoprotein(a) concentrations. Front Cardiovasc Med. 2021; 8: 807925.
  16. Cui K, Yin D, Zhu C, et al. How do lipoprotein(a) concentrations affect clinical outcomes for patients with stable coronary artery disease who underwent different dual antiplatelet therapy after percutaneous coronary intervention? J Am Heart Assoc. 2022; 11(9): e023578.
  17. Liu HH, Cao YX, Jin JL, et al. Predicting cardiovascular outcomes by baseline lipoprotein(a) concentrations: a large cohort and long-term follow-up study on real-world patients receiving percutaneous coronary intervention. J Am Heart Assoc. 2020; 9(3): e014581.
  18. Willeit P, Ridker PM, Nestel PJ, et al. Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials. Lancet. 2018; 392(10155): 1311–1320.
  19. Joint committee issued Chinese guideline for the management of dyslipidemia in adults. [2016 Chinese guideline for the management of dyslipidemia in adults]. Zhonghua Xin Xue Guan Bing Za Zhi. 2016; 44(10): 833–853.
  20. White HD, Thygesen K, Alpert JS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012; 33(20): 2551–2567.
  21. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007; 115(17): 2344–2351.
  22. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011; 123(23): 2736–2747.
  23. Szarek M, Bittner VA, Aylward P, et al. Lipoprotein(a) lowering by alirocumab reduces the total burden of cardiovascular events independent of low-density lipoprotein cholesterol lowering: ODYSSEY OUTCOMES trial. Eur Heart J. 2020; 41(44): 4245–4255.
  24. Tsimikas S, Karwatowska-Prokopczuk E, Gouni-Berthold I, et al. Lipoprotein(a) reduction in persons with cardiovascular disease. N Engl J Med. 2020; 382(3): 244–255.
  25. Burgess S, Ference BA, Staley JR, et al. Association of LPA variants with risk of coronary disease and the implications for lipoprotein(a)-lowering therapies: a mendelian randomization analysis. JAMA Cardiol. 2018; 3(7): 619–627.
  26. Lamina C, Kronenberg F. Lp(a)-GWAS-Consortium. Estimation of the required lipoprotein(a)-lowering therapeutic effect size for reduction in coronary heart disease outcomes: a mendelian randomization analysis. JAMA Cardiol. 2019; 4(6): 575–579.
  27. Madsen CM, Kamstrup PR, Langsted A, et al. Lipoprotein(a)-lowering by 50 mg/dL (105 nmol/L) may be needed to reduce cardiovascular disease 20% in secondary prevention: a population-based study. Arterioscler Thromb Vasc Biol. 2020; 40(1): 255–266.
  28. Fox KAA, Carruthers KF, Dunbar DR, et al. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur Heart J. 2010; 31(22): 2755–2764.
  29. Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015; 36(19): 1163–1170.