Objectives: We sought to evaluate if elevated lipoprotein(a)[Lp(a)] is associated with worse outcome in symptomatic patients of having coronary artery disease(CAD), and moreover clarify the role of Lp(a) as an independent risk factor for adverse cardiac events in the era of coronary artery revascularization. Background: Although, Lp(a) has been considered as cardiovascular risk factor for many years, there is paucity of data in regard with the potential risk of Lp(a) for symptomatic patients of having CAD. Methods: 6252 consecutive subjects (59.2% male, mean age 61.2짹11.2 years) suspected of having CAD underwent coronary angiography. Laboratory values for lipid parameters including Lp(a) were obtained at the day of coronary angiography and analyses were done shortly after sampling. 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 3.1짹2.2 years, there were 100 MACE (56 cardiac death and 44 non-fatal MI) with an event rate of 1.6%. Kaplan-Meier survival analysis revealed that elevated Lp(a) was associated with worse outcome (p<0.0001). Furthermore, elevated Lp(a) was a significant predictor of MACE on univariate and multivariate Cox proportional survival analysis [hazard ratio 2.092 (95% confidence interval 1.41–3.10, p<0.0001) and 1.773 (95% confidence interval 1.19–2.63, p=0.005), respectively]. Conclusions: Elevated Lp(a) has 1.8-fold increased risk of cardiovascular events in symptomatic patients of having coronary artery disease, irrespective of coronary artery revascularization status. Table 1. Univariate and multivariate Cox regression analysis for predicting MACE (non-fatal MI and cardiac death)