Elevated lipoprotein(a) and hs-CRP as a Poor Prognostic Marker in Patients with Coronary Artery Disease

초록

Objectives We sought to evaluate the prognostic value of elevated lipoprotein(a) [Lp(a)] and high sensitive C-reactive protein (hs-CRP) in patients with coronary artery disease (CAD). Methods 5785 patients (60.3% male, mean age 61.3 ±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Lp(a) and hs-CRP levels were obtained at the day of coronary angiography and analyses were done shortly after sampling. Patients were divided into four groups according to their Lp(a) and hs-CRP levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and major adverse cardiovascular event (MACE) including cardiac death and non-fatal myocardial infarction (MI) were recorded. Results Over a mean follow-up period of 4.4 ± 2.5 years, there were 131 MACEs (75 cardiac death and 56 non-fatal MI) with an event rate of 2.3%. Mean Lp(a) level and hs-CRP levels were 21.5 ± 24.6 mg/dl and 6.3 ± 19.7 mg/dl, respectively. Kaplan-Meier survival analysis revealed that elevated Lp(a) and hs-CRP was associated with adverse cardiac outcome (p < 0.0001). Furthermore, multi-variate Cox regression analysis after adjustment of age, diabetes, smoking, hypertension, hypercholesterolemia and extent of CAD revealed that elevated Lp(a) and hs-CRP was associated with worse prognosis [HR 5.441, 95% CI 3.154-9.388 (p < 0.0001)]. Conclusions Elevated lipoprotein(a) and hs-CRP is associated with worse prognosis in patients with CAD.