Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor, yet its association with coronary lesion complexity in Asian populations undergoing percutaneous coronary intervention (PCI) remains inadequately characterized.

We conducted a retrospective analysis of 1,829 consecutive Asian patients who underwent PCI with measured Lp(a) levels. Given ethnic variations in Lp(a) distribution, we used an Asian population-appropriate threshold of ≥30 mg/dL as the primary cutoff, with 50 mg/dL analyzed as secondary comparison. Lesion complexity was assessed using a 6-component score (range 0-6) including chronic total occlusion, ≥2 stents, total stent length ≥60mm, bifurcation lesions, multivessel disease, and severe calcification. We applied 1:1 propensity-score matching and multivariable linear regression to adjust for confounding.

Of 1,829 patients (mean age 63.3 ± 10.9 years; 67% male), 639 (35%) had Lp(a) ≥30 mg/dL. Before matching, mean complexity scores were 2.34 ± 2.01 vs 1.35 ± 1.46 (Lp(a) ≥30 vs <30; P < 0.001). After matching (n = 498 vs 498), elevated Lp(a) remained associated with higher complexity (2.28 ± 1.98 vs 1.45 ± 1.54; P < 0.001). In adjusted models, Lp(a) ≥30 mg/dL independently predicted higher complexity (β = 0.834; 95% CI, 0.656–1.012; P < 0.001), along with diabetes (P < 0.001), LDL-C (per 10 mg/dL β = 0.03; P < 0.01), age (per year β = 0.011; P < 0.01), and lower LVEF (per 10% β = −0.17; P < 0.001). A dose-response was evident across Lp(a) categories—<30, 30–49, and ≥50 mg/dL—with ascending scores (1.35 ± 1.46, 2.31 ± 1.96, 2.37 ± 2.07; P trend < 0.001). Findings were similar using the ≥50 mg/dL cutoff (P < 0.001)

Elevated Lp(a) ≥30 mg/dL independently predicts significantly higher coronary lesion complexity in Asian patients undergoing PCI, with associations persisting after rigorous adjustment for confounders through both propensity matching and multivariable regression. These findings demonstrate that Lp(a) serves not only as a cardiovascular risk biomarker but also as a predictor of procedural complexity, supporting routine Lp(a) screening to enhance pre-procedural risk stratification and guide lesion preparation strategies in Asian populations.