Extended dual antiplatelet therapy beyond 1 year cuts ischaemic events in ACS patients with elevated Lp(a), but not those with normal Lp(a), in 4,357 PCI patients (Cardiol J 2024)

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

Cardiol J · 19 October 2023 · 7

Cui K, Wu S, Yin D, Song W, Wang H, Zhu C, Feng L, Yang Y, Fu R, Dou K

In the Fuwai PCI Registry, 4,357 acute coronary syndrome patients who were event-free at 1 year after percutaneous coronary intervention were stratified by dual antiplatelet therapy (DAPT) duration (<=1 year vs >1 year) and Lp(a) level (<=30 mg/dL vs >30 mg/dL). Over 2.4 years of further follow-up, extended DAPT (>1 year) was associated with significantly lower risk of major adverse cardiovascular and cerebrovascular events in patients with elevated Lp(a) (adjusted HR 0.284, 95% CI 0.115-0.700; IPTW-weighted HR 0.351, 95% CI 0.164-0.751), but showed no significant benefit in patients with normal Lp(a). Bleeding risk did not differ by DAPT duration regardless of Lp(a) level. The findings suggest Lp(a) could help identify ACS patients who benefit most from prolonging dual antiplatelet therapy beyond one year.

Original abstract

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.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.